慢性乙型肝炎患者肝穿刺病理与血清HBV-DNA载量、肝纤维化血清学指标关系

Relationship between hepatic pathological changes and levels of serum HBV-DNA,hepatic fibrosis markers in chronic hepatitis B patients

目的探讨慢性乙肝患者肝脏病变程度与血清HBV-DNA含量的关系及肝组织纤维化分期与血清纤维化指标之间的关系。方法59例慢性乙肝患者根据血清免疫学指标分为HBeAg阳性组和HBeAg阴性组,均进行肝穿刺组织学检查及采用荧光实时定量PCR法检测HBV-DNA、放免法(R IA)检测血清纤维化指标(HA、LN、PCⅢ、C IV)。结果HBeAg阳性组患者不同炎症分级的HBV-DNA水平有显著性差异,不同纤维化分期的HBV-DNA水平差异无统计学意义,HBeAg阴性组患者不同炎症分级和纤维化分期的HBV-DNA水平差异无统计学意义。血清HA、PCⅢ、C IV水平随着纤维化程度加重而递增。结论HBeAg阳性组患者中随着炎症损伤加重,HBV-DNA水平增高。HBeAg阴性组肝脏病变程度与HBV-DNA水平无直接相关,不同HBV-DNA水平者均应及时进行肝活检明确病变程度。而联合检测血清HA、LN、PCⅢ、C IV是反映肝脏纤维化程度的良好指标。

Aim To discuss the relationship between hepatic pathological changes and the quantitative determination of HBV-DNA and the relationship between liver fibrosis and serum levels of hepatic fibrosis markers in patients with chronic hepatitis B. Methods 59 patients were divided into two groups according to the serum immunological markers, HBeAg-positive group and HBeAg-negative group. These cases had liver histopathologic assay, serum HBV-DNA by fluorescent quantitative PCR and serum levels of hepatic fibrosis markers by RIA. Results There was significant difference in the serum level of HBV-DNA among various inflammation grades in HBeAg-positive group. No significant difference was found between the serum levels of HBV-DNA in the different stages of liver cirrhosis. These levels in HBeAg-negative group have no statistics discrepancy. The increase in serum HA ,PC Ⅲ, CIV was correlated with the progression of liver fibrosis. Conclusions The serum level of HBV-DNA in HBeAg-positive group gradually increased with the development of inflammation. Because no significant correlations were shown between HBV-DNA quantitation and hepatic pathological change in HBeAg-negative group, liver histology is vatuable in diagnosis of liver damage with different HBV-DNA. Combined examing HA, LN, PC Ⅲ, CIV has diagnostic value of hepatic fibrosis.