非甲-非戊型慢性病毒性肝炎患者隐匿性HBV感染的研究

Occult hepatitis B virus infection in chronic viral hepatitis patients with non-A to E hepatitis virus infection

目的观察非甲-非戊型慢性病毒性肝炎患者隐匿性HBV感染的状况，探讨荧光定量聚合酶链反应（FQ-PCR）技术对隐匿性HBV感染的诊断价值。方法应用FQ-PCR技术对57例非甲．非戊型慢性病毒性肝炎患者进行了血清、肝组织HBV-DNA定量检测，并将肝组织HBVDNA定量水平与肝脏炎症活动度的关系进行了分析。结果血清、肝组织HBVDNA定量阳性分别为13例（22．81％）、22例（38．60％）。13例血清HBVDNA定量阳性患者其肝组织定量亦均阳性，但9例肝组织HBVDNA定量阳性患者其血清定量为阴性，差异有统计学意义（P〈0．01）；同时13例血清与肝组织定量均阳性患者比较，显示肝组织HBVDNA定量水平显著高于血清定量水平[（6．62±1．21）拷贝／g vs．（4．03±1．06）拷贝／ml，（P〈0．01）]。肝组织HBVDNA水平与肝脏炎症活动度并无相关性，10例G2，7例G3，5例G4患者HBVDNA定量分别为（6．13±1．65）拷贝/g、（5．92±1．81）拷贝/g、（5．83±1．89）拷贝／g，（P〉0．05），但HBVDNA定量阳性患者均为活动性肝脏病变。结论HBV隐匿性感染是部分非甲-非戊型慢性病毒性肝炎患者的病因。单纯检测血清免疫学标志物对HBV感染诊断存在漏诊，对非甲-非戊型慢性病毒性肝炎患者应用FQ-PCR技术开展血清定量尤其是肝组织中HBV DNA定量检测可提高HBV感染的诊断。对隐匿性HBV感染的慢性病毒性肝炎亦应给予有效的抗病毒治疗。

Objective To observe the status of occult hepatitis B virus infection in chronic viral hepatitis patients with non-A to E hepatitis virus infection and explore the diagnostic value of fluorescence quantitative polymerase chain reaction （FQ-PCR） technique for occult hepatitis B virus infection. Methods The amount of HBV-DNA in serum and liver tissue from 57 patients with non-A to E hepatitis virus infection who were diagnosed as chronic viral hepatitis by Menghini method liver biopsy were detected by using FQ-PCR technique, then the relation between the viral load of HBV DNA in liver tissue and hepatic inflammatory activity were analyzed. Results Thirteen （22.81% ）,22（38.60%） patients were positive for HBV DNA in serum and liver tissue,respectively. The positive rate and the level of HBV DNA quantity in liver tissue were significantly higher than those in serum; HBV DNA was found positive in both serum and liver tissue in 13 cases, negative in both serum and liver tissue in 35, positive in liver tissue but negative in serum in 9, and in none of the cases HBV DNA was positive in serum but negative in liver tissue （ P 〈 0.01 ）. The logarithmic value of HBV DNA from 13 patients in liver tissue and in serum was respectively：（6.62±1.21 ） copies/g vs. （4.03±1.06） copies/ml, P 〈 0.01. The hepatic lesions of all HBV DNA positive patients were active pathologic changes, but the level of HBV DNA in liver tissue was not significantly correlated with the grade of hepatic inflammation activity （P〉0.05）. Conclusion Occult HBV infection is the etiology of part of the chronic viral hepatitis patients with non-A-E hepatitis virus infection. Missed diagnosis will occur if diagnosis of hepatitis B is only based on detection of serum HBV markers. It is useful for improvement of the diagnostic level of HBV infection via detection of HBV DNA quantitatively in serum especially in liver tissue of chronic viral hepatitis patients with non-A-E hepatitis virus infection by using FQ-PCR technique. The chronic viral hepatitis patients with occult HBV infection should be also given effective anti-viral therapy.