重型乙型肝炎血清HBV DNA水平与肝功能及免疫指标的关系研究

A study on the correlation between the level of serum HBV DNA and liver function and immunological index in patients with severe hepatitis B

目的 探讨重型乙型肝炎患者血清HBV DNA水平与肝损害程度以及血清免疫指标之间的关系.方法 应用荧光定量聚合酶链反应法和酶联免疫吸附法（ELISA）分别检测197例乙肝患者血清HBVDNA水平与乙型肝炎病毒血清标志物（HBVM）.结果 重型乙型肝炎患者血清HBV DNA水平显著低于慢乙肝重度,慢乙肝轻、中度及急性乙肝（P＜0.01）;重型乙型肝炎患者HBeAg阴性率最高（P＜0.05）;重型乙肝患者血清HBV DNA水平与ALT、TBil无相关性,与C3、C4呈显著正相关（P＜0.01）,与PT、IgG、IgA、IgM呈显著负相关（P＜0.05～0.01）;重型乙型肝炎死亡患者血清HBV DNA水平显著低于存活者（P＜0.05）.结论 重型乙型肝炎血清HBV DNA复制水平低,HBeAg阴性率高,与病毒变异有关;重型乙型肝炎血清HBV DNA水平与肝功能及免疫指标有良好相关性;定量检测重型乙型肝炎患者血清HBV DNA对判断病情危重程度、指导抗病毒治疗和估计预后有重要意义.

Objective To explore the correlation between the level of serum HBV DNA and the degree of liver damage and immunological index in patients with severe hepatitis B. Methods The levels of serum HBV DNA and HBV markers were measured by fluorescence quantitanve PCR and ELISA respectively in 197 cases with hepatitis B. Results The levels of serum HBV DNA in patients with severe hepatitis B were lower significandy than those in patients with mild, moderate, heavy chronic hepatitis B and acute hepatitis B（ P 〈 0.01 ）;The negative rate of HBeAg in patients with severe hepatitis ]3 was the highest（ P 〈 0.05）;The level of serum HBV DNA in patients with severe hepatitis B had not correlation with ALT and TB, but had significantly positive correlation with C3 and C4 （P 〈 0.01 ）, and significantly negative correlauon with PT, IgG, IgA and IgM （P 〈 0.05- 0.01 ）;The levels of serum HBV DNA in dead patients with severe hepatitis B were lower significantly than those in survivals（P 〈 0, 05）.Conchlsions Low levels of HBV duplication and high negative rate of HBeAg can result from viral mutant; there is a good correlation between the levels of serum HBV DNA and liver function and immunological index in patients with severe hepatitis B;Quantitative measurement of serum HBV DNA is significant for estimating the degree of illness,instructing antivirus therapy, and evaluating prognosis.