乙型肝炎病毒载量与患者血清标志物及病情的关系

The correlation of hepatitis B virus loads with serologic markers and patient's condition

目的:回顾性分析乙型肝炎患者HBV载量与其血清标志物及病情之间的关系。方法:选取乙型肝炎患者814例作为研究对象,其中急性肝炎75例,慢性肝炎558例,重型肝炎181例,HBV载量采用实时荧光定量PCR(RTFQ-PCR)检测。血清HBV标志物的检测采用ELISA法。结果:在HBeAg阳性模式中,HBV DNA载量为阳性者占95.9%(372/388),其中>107Copies/ml者占67.3%(261/388),显著高于其他各种模式(P<0.01)。在抗-HBe阳性模式中,HBV DNA载量为阳性者占43.2%(126/292),其中>107Copies/ml者占11.3%(33/292)。在HBsAg阴性模式中,15例HBV DNA载量阳性,占22.7%(15/66)。慢性乙型肝炎轻、中、重度3组患者间HBV DNA载量差异无显著性意义(P>0.05);重型乙型肝炎患者中,HBV DNA载量>107Copies/ml者占20.4%(37/181),明显低于慢性肝炎患者(48.1%,268/558)(P<0.01)。结论:部分HBeAg发生血清转换的患者可能是HBV基因变异所致,其HBV DNA仍可呈现高水平复制,因此血清标志物指标需结合病毒载量一起分析才能得出更可靠的结论。急性乙型肝炎恢复期时,HBsAg消失后,HBV DNA仍可持续存在一段时间,因此需进一步随访监测。HBV复制活跃不一定是导致重型肝炎发生的原因,HBV DNA载量与患者病情严重程度之间并不呈明确的相关性。

Objective：To analyze retrospectively the correlation of HBV loads with HBV serologic markers and patient＇s conditlon.Methods： 814 patients with hepatitis B were selected as study objects. The patients with acute hepatitis, chronic hepatitis and severe hepatitis were 75, 558 and 181 respectively. HBV loads of the patients were assayed by real time fluorescent quantitative PCR （RTFQ-PCR） .HBV serologic markers of the patients were detected by ELISA.Results： In the HBeAg-positive patients. HBV DNA loads were positive accounted for 95.9 % （372/388） and the patients whose HBV copies were more than 107copies/ml accounted for 67.3% （261/388）, which was significantly higher than other various models of serologic markers （P〈0.01） . In the anti-HBe positive patients, HBV DNA loads were positive accounted for 43.2% （126/ 292） and the patients whose I-IBV copies were more than 107 copies/ml accounted for 11.3 % （33/292） . In the HBsAg-negative patients, HBV DNA loads were positive accounted for 22.7 % （15/66） . The HBV loads have no significant differences among the patients with chronic hepatitis B in the slight, moderate and gravis groups （P 〉0.05） . In the patients with severe hepatitis B, the HBV DNA loads were more than 107 copies/ml accounted for 20.4% （37/181）, which was obviously lower than the patients with chronic hepatitis B （48.1%, 268/558） （P〈0.01） .Conclusion： The HBeAg seroconversion in some patients was resulted possibly by HBV genovariation, and the replication of HBV DNA of those patients still existed high level. In the recovery stage of acute hepatitis B, because HBV DNA could still present some time after disappear of HBsAg, follow up and monitoring of these patients were necessary. The active replication of HBV was not a sure reason for the occurrence of severe hepatitis, and there were no obvious associations between the HBV loads and grave degree of the patient＇s condition.