HBeAg阴性和阳性慢性乙型肝炎患者肝穿刺活检比较

Comparison on liver tissue biopsy changes of the two states of HBeAg positivity and negativity in the patients with chronic hepatitis B

目的探讨乙型肝炎病毒(HBV)HBeAg阳性和阴性两种病原学状态对慢性乙型肝炎患者肝组织的影响。方法对266例行肝活检的慢性乙型肝炎患者做免疫组化检测肝组织HBsAg、HBcAg;采用双抗体夹心酶联免疫法检测血清前S1蛋白、HBV-DNA、HBsAg、抗HBs、HBeAg、抗HBe、抗HBc。按肝组织炎症、纤维化程度分组,比较HBeAg阳性和阴性的分布,并比较肝组织中HBsAg、HBcAg在HBeAg阳性组和阴性组的阳性率。结果通过肝活检发现,按肝组织炎症程度分组,HBeAg阳性组和阴性组患者主要分布于G1～G3,分别占本组总数的92.35%和92.77%,分别两两比较无显著性差异。G3、G4之和比较,两组间有显著性差异(P<0.05),提示HBeAg阳性组重度肝炎的发生率较阴性组为高。按肝组织纤维化病变程度分组,在HBeAg阳性组患者分布为S1>S2>S3>S0>S4;HBeAg阴性组患者分布为S1>S0>S2>S3>S4。两组间比较无显著性差异(P>0.05)。肝硬化阶段HBeAg阴性组患者发生率偏高,两组间比较有显著性差异(P<0.05)。血清前S1蛋白、HBV-DNA及肝组织中的HBsAg、HBcAg在HBeAg阳性组的阳性率明显高于HBeAg阴性组(P<0.005)。结论肝组织炎症程度方面,HBeAg阳性组重度肝炎发生率比阴性组高;纤维化病变程度方面,HBeAg阴性组肝硬化发生率比阳性组高。HBeAg阳性组血清前S1蛋白、HBV-DNA及肝组织中的HBsAg、HbcAg等病毒复制指标的显阳率明显高于HBeAg阴性组。

Objective To investigate the influence of the two states of HBeAg positivity and negativity in the patients with chronic hepatitis B on their liver tissues. Method The HBsAg and HBeAg in liver tissue were detected by the immunological histoehemistry in 266 patients which liver biopsy were performed. Pre-s1, HBsAg, anti-HBsAg, HBeAg, anti-HBe and anti-HBe in serum were detested by using the double antibody ELISA. The patients were classified into some groups according to lever inflammation and lever fibrosis. The distribution of HBeAg positivity and negativity in various groups and the rates of HBsAg and HBeAg in liver tissue in those groups of HBeAg positivity and negativity were eomparied. Result According to the degree of lever inflammation,the patients of HBeAg positivity and negativity were mainly at G1-G3,the former was 92.35%, the latter was 92.77%. There were no considerable differences among those groups. Comparing the sum of G3 and G4, there was remarkable differences （P〈0.05）, whieh indicated the rate of severe hepatitis patients was higher in group of HBeAg positivity than that of negativity. According to the degree of lever fibrosis, the patients＇ distribution of positive HBeAg group were S1〉S2〉S3〉S0〉S4. the patients＇ distribution of negative HBeAg group were S1〉 S0〉S2〉S3〉S4. There were no remarkable differences between groups of HBeAg＇ positivity and negativity（P〉 0.05）. But the rate at cirrhosis of liver in the group of HBeAg negativity was higher than that of positivity group （P〈0.05）. Conclusion The incidence of severe hepatitis patients in group of HBeAg positivity is higher than that of negativity. The incidence of liver cirrhosis in the group of HBeAg negativity is higher than that of positivity. The rate of pro-s,HBV-DNA in serum and HBeAg, HBsAg in lever tissue in the group of HBeAg positivity are more than that of negativity.