HBeAg阴性和HBeAg阳性乙型肝炎肝硬化患者临床特征及预后的前瞻性研究

The prospective study of the clinical features and outcome of HBeAg-negative and HBeAg-positive cirrhosis in patients with chronic type B hepatitis

目的对乙型肝炎病毒e抗原（HBeAg）阴性及HBeAg阳性乙型肝炎肝硬化患者的临床特征及预后进行对照研究。方法观察217例乙型肝炎肝硬化患者35个月（3～47个月），对HBeAg阴性及HBeAg阳性乙型肝炎肝硬化患者的临床特征及预后进行对照研究。结果在所观察人群中，HBeAg阴性乙型肝炎肝硬化多于HBeAg阳性乙型肝炎肝硬化；HBeAg阴性患者的中位丙氨酸转氨酶及天冬氨酸转氨酶水平低于HBeAg阳性患者；HBeAg阴性患者中位白细胞，血红蛋白及血小板水平低于HBeAg阳性患者；HBeAg阴性患者中HBVDNA阳性率及HBVDNA〉10^5拷贝／ml患者比例低于HBeAg阳性患者；HBeAg阴性乙型肝炎肝硬化患者病死率高于HBeAg阳性乙型肝炎肝硬化患者；在HBeAg阴性患者组，口服拉米夫定进行抗病毒治疗者腹水、出血及肝癌的发生率低于未抗病毒治疗者。抗病毒治疗患者在整个研究期间未出现肝硬化相关并发症的患者比例高于未抗病毒治疗患者，而出现1～2个并发症的患者比例低于未抗病毒治疗患者；在HBeAg阳性患者组，口服拉米夫定进行抗病毒治疗者腹水的发生率低于未抗病毒治疗者，抗病毒治疗患者在整个研究期间未出现肝硬化相关并发症的患者比例高于未抗病毒治疗患者。结论HBeAg阴性肝硬化患者其生化指标，外周血细胞计数，HBVDNA载量等均低于HBeAg阳性组。HBeAg阴性肝硬化患者病死率高于HBeAg阳性组。

Objective Comparing clinical features and prognosis between HBeAg-negative and HBeAg-positive cirrhosis in patients with chronic type B hepatitis. Methods 217 chronic type B hepatitis with cirrhosis patients were prospectively studied for 35 months （3-47 months）. Comparing clinical features and prognosis between HBeAg-negative and HBeAg-positive cirrhosis in patients with chronic type B hepatitis. Results The numbers of HBeAg-negative cirrhosis in patients with chronic type B hepatitis were more than HBeAg-positive cirrhosis ;The median ALT and AST levels of HBeAg-negative patients were lower than HBeAg-positive patients; The median WBC, HGB and PLT levels of HBeAg-negative patients were lower than HBeAg-positive patients; HBV DNA positive rate and proportion of HBV DNA 〉 10^5 copies/ml of HBeAg-negative patients was lower than HBeAg-positive patients; The mortality rate of HBeAg-negative patients was higher than HBeAg-positive patients;among HBeAg-negative patients group, the presence rate of ascite, portal hypertensive gastrointestinal bleeding and HCC of patients treated with lamivudine were lower than the other patients, the proportion of non-presence of complications patients treated with lamivudine were higher than the other patients, the proportion of presence of one-two complications patients treated with lamivudine were lower than the other patients ; among HBeAg-positive patients group, the presence rate of ascite of patients treated with lamivudine were lower than the other patients, the proportion of non-presence of complications patients treated with lamivudine were higher than the other patients. Conclusion Among the liver cirrhosis patients, the numbers of HBeAg-negative cirrhosis were more than HBeAg-positive cirrhosis; HBeAg-negative patients with cirrhosis have lower liver inflammation activity; HBeAg-negative patients with cirrhosis have lower WBC, HGB and PLT levels;HBV DNA positive rate and proportion of HBV DNA 〉 10^5 copies/ml of HBeAg-negative patients was lower than HBeAg-positive patients; The mortality rate of HBeAg-negative patients was higher than HBeAg-positive patients ; Lamivudine treatment is beneficial in HBeAg-negative and HBeAg-positive cirrhosis patients.