799例重型肝炎患者的临床病原学与实验室分析

An analysis of the relationship between HBV DNA and HBeAg expression and mortality in 799 severe hepatitis patients

目的探讨乙型重型肝炎患者乙型肝炎病毒(HBV)DNA定量、e抗原表达与病死率的相关性,为重型肝炎临床治疗提供参考。方法统计我院2000-2004年各型重型肝炎的发病率,进一步应用荧光定量多聚酶链反应方法检测乙型重型肝炎患者血清HBV DNA,应用微粒子方法检测乙型肝炎e抗原表达情况,并分析其与病死率及抗病毒治疗的临床疗效间的关系。结果(1)重型肝炎中乙型肝炎占83．50％,慢性重型肝炎中乙型肝炎占96．77％;(2)5年间慢性乙型重型肝炎患者HBV DNA定量大于1×10,拷贝／ml组,总病死率为53．25%,小于1×105拷贝／ml组,病死率为34．50％,差异有统计学意义(P<0．01);e抗原表达对病死率无影响;(3)2004年,慢性乙型重型肝炎患者HBV DNA定量大于1×105拷贝／ml病例加用拉米夫定抗病毒治疗,病死率由2000年的54．64%下降至2004年的30．38%,差异有统计学意义(P<0．01)。结论重型肝炎以慢性乙型重型肝炎为主,病毒载量高是高病死率关键因素之一,抗病毒治疗可以降低患者的病死率。

Objective To evaluate the relationship between mortality and HBVDNA and HBeAg expression of severe hepatitis B patients. Methods The mortality rates of different types of severe hepatitis patients in our hospital during the last five years were anylysed. HBV DNA was detected using the fluorescence quantitative PCR method and the HBeAg expression of severe hepatitis B was studied using a microparticle method. Results （1） Hepatitis B morbidity was 83.5% in each type of severe hepatitis, and severe chronic hepatitis B morbidity was 96.77% in each type of severe chronic hepatitis. （2） The mortality rate of those with HBV DNA 〉 1 × 10^5 copies/ml was 53.25% and the mortality of those with HBV DNA 〈 1 × 10^5 copies/ml was 34.50% （P 〈 0.01）. The HBeAg expression had no influence on the death rate. （3） The death rate descended to 30.38% from 54.64% （HBV DNA 〉1 × 10^5 copies/ml） when treated with Lamivudine （P 〈 0.01）. Conclusion In severe hepatitis the quantity of virus carried in the patient is one of the key factors of mortality; antivirus treatment can lower mortality.