手术干预前后HBsAg阳性患者HBV-DNA的变化及其临床意义

THE CHANGES AND SIGNIFICANCE OF SERUM HBV-DNA LEVEL IN HBsAg POSITIVE PATIENTS BEFORE AND AFTER OPERATION

[目的]探讨HBsAg阳性患者经外科手术干预前后HBV-DNA的变化及临床意义。[方法]采用时间分辨免疫荧光分析法58例HBsAg阳性手术患者术前血清HBV-M,采用实时荧光定量PCR检测了HBsAg阳性手术患者术前和术后d3、d7血清HBV-DNA的变化情况。[结果](1)58例HBsAg阳性手术患者中27例血清中可检测到HBV-DNA,阳性率为46.1%,HBV-M的各种感染标志组合均有HBV-DNA检出。(2)27例检测到HBV-DNA的患者经外科手术干预后d3和d7,血清HBV-DNA拷贝数比术前显著增高(P﹤均0.01),另有4例术前感染标志组合表现为HBsAg、抗-HBe、抗-HBc阳性,但血清未检出HBV-DNA的患者,术后血清出现了104～106拷贝的HBV-DNA。[结论](1)各种感染标志组合的HBsAg阳性手术患者体内存在乙肝病毒的活动,外科手术的干预可引起病毒复制增强,临床应重视HBV-DNA的监测,进行必要的抗病毒治疗。

[Objective] To investigate the changes of serum HBV-DNA level in HBsAg positive patients before and after operation and its clinical significance. [Methods] HBV markers （HBV-M） in serum was detected in 58 HBsAg positive patients by time-resolved fluoroimmunometric assay before operation. HBV-DNA levels in serum of them in the 3rd, 7th day after operation were detected by real time fluoresent quantitative polymerase chain reaction. [ Results] HBV-DNA was detected out in 27 of 58 HBsAg positive patients and the positive rate was 46.1%. HBV-DNA was detected out in each type of HBV-M patients. After operation, serum HBV-DNA increased remarkably at the 3rd and the 7th day in these 27 patients （P 〈 0.01 ）. Morover, there were 4 patients, whose serum HBV-M was HBsAg, HbeAb, HbcAb positive but without HBV-DNA detection before operation and with 104-106 copies of HBV-DNA after operation. [Conclusion] Hepatitis B virus can strongly replicate in I-IBsAg positive patients. Surgical interventions may promote the replication of HBV. It is necessary to monitor the quantity of virus and treat the patients with antiviral therapy.