血清e抗原状态及甲胎蛋白水平对慢性重型乙型肝炎预后的影响

Association of HBeAg positivity and alpha fetoprotein level with the prognosis of chronic severe hepatitis B

目的探讨血清e抗原状态及甲胎蛋白(AFP)水平对慢性重型乙型肝炎预后的影响。方法回顾分析2002年1月至2007年12月在我院住院的慢性重型乙型肝炎患者325例,研究血清e抗原状态及血清AFP水平对疾病预后的影响。结果325例慢性重型乙型肝炎中,HBeAg阳性168例(51.7%),HBeAg阴性157例(48.3%)。HBeAg阳性组与HBeAg阴性组比较,两组间男女构成比、平均总胆红素峰值及平均凝血酶原活动度谷值均无显著差异;HBeAg阴性组平均年龄及肝硬化比例均显著高于HBeAg阳性组(P值均<0.001);HBeAg阴性组好转率显著低于HBeAg阳性组(P<0.05)。在168例HBeAg阳性与157例HBeAg阴性病人中,均显示随着血清AFP的升高,其好转率亦升高,呈显著正相关(P值分别<0.001、0.05)。结论HBeAg阴性重型乙型肝炎较HBeAg阳性者预后差;不管HBeAg状态如何,血清AFP水平越高,慢性重型乙型肝炎预后越好。

Objective To explore the association ofHBeAg positivity and alpha fetoprotein （AFP） level with the prognosis of chronic severe hepatitis B. Methods A total of 325 hospitalized patients with chronic severe hepatitis B were analyzed for serum HBeAg positivity and AFP levels and their association with the prognosis. Results Of all the 325 patients, 168 （51.7%） were HBeAg-positive and 157 （48.3%） were HBeAg-negative, and the two groups showed no significant difference in gender distribution, average peak value of total bilirubin and average trough prothrombin activity. Compared with the positive patients, the HBeAg-negative patients had significantly older age （P〈0.001）, higher rate of liver cirrhosis （P〈0.001） and lower response rate （P〈0.05）. Elevated AFP level was positively correlated to the response rate in both the HBeAg-positive （P〈0.001） and negative patients （P〈0.05）. Conclusions HBeAg-negative patients with chronic severe hepatitis B have poorer prognosis than the HBeAg-positive patients, and higher AFP levels are associated with more favorable prognosis regardless of the HBeAg positivity.