慢性乙型肝炎患者检测血清cccDNA的临床意义

The Clinical Study of Detecting cccDNA in Patients' Sera Suffered Chronic Hepatitis B

目的:了解慢性乙型肝炎患者血清中共价闭合环状DNA(cccDNA)的检测阳性率和定量值及其与肝脏损害的临床内在联系。方法:随机选取轻度、中度、重度及重型慢性乙型肝炎患者、肝硬化患者、乙肝病毒携带者各20例。使用实时荧光定量PCR法同时检测血清中cccDNA、HBV DNA值及ALT、AST、TBIL值。结果:HBV DNA阳性100例中cccDNA阳性53例,HBV DNA阴性20例中cccDNA阳性2例,差异显著(P<0.01);轻度、中度、重度及重型慢性乙型肝炎患者,肝硬化患者和乙肝病毒携带者血清cccDNA检出阳性分别为15、13、17、10、2、1例;轻度、中度、重度及重型慢性乙型肝炎患者cccDNA检出阳性者在发病的极期连续多次检测均阳性,恢复期转阴;轻度、中度、重度及重型慢性乙型肝炎患者cccDNA检出阳性率与乙肝病毒携带者和肝硬化患者有显著差异(P<0.01)但组间差异不明显;轻度及中度慢性乙型肝炎患者、重度及重型慢性乙型肝炎患者及乙肝病毒携带者和肝硬化患者3组之间cccDNA水平分布位置不相同(P<0.01);120例患者血清中cccDNA值和ALT秩相关(P<0.01);cccDNA值与AST秩相关(P<0.01);cccDNA值与TBIL秩无相关。结论:病毒明显复制且炎症活动明显时的乙肝患者血清cccDNA阳性检出率高;可能为肝脏急性显著损害的指标之一;可作为判断病毒明显复制时肝功能显著损害的又一临床参考参数。

Objective：To study the clinical relationship between the detecting of covalently closed circular DNA （cccDNA） positive rate and quatitation. Methods： Randomly selected slight,modrate, serious, grave patients infected chronic viral hepatitis B hepafic cirrhosis and Chronic asymptomatic carrieres respectively 20 cases,then applied real-time fluorescent quantitative PCR to measure cccDNA, HBVDNA, ALT, AST, and TBIL in sera simultaneously. Results： Fifty-three cccDNA in 100 patients was positive whose HBVDNA was positive while 2 cccDNA in another 20 was positive whose HBVDNA was negative. Seeing from the up statement, the difference was obvious, eecDNA was positive respectively 15,13,17,10,2 and I in the six ranked HBV infected patients slight, modrate, serious and grave chronic hepatitis B infectious patients whose cccDNA was positive were always positive in several detecting experiment at the peak time of the disease, but reverse at the recovering time. There were outstanding distinctions in detecting cccDNA positive rate among siight,modrate, serious and grave chronic hepatitis B infected patients, Chronic asymptomatic carrieres and hepatic cirrhosis patients （P〈0.01）, but the difference among each group was not so marked. There was significantly difference among the former 4th types and the following two groups in detecting cccDNA in sera （P〈0.0l）. From the study of 120 randonly choosen patients, cccDNA level was correlated with ALT and AST （P〈0. 01） ,but cccDNA was not related to TBIL. Conclusion：The cccDNA＇s positive rate is high in the patients＇ sera sufferd chronic viral hepatitis B when the virus is active and inflammation exists in. Maybe the cccDNA was another important clinical parameter to identify the virus is copying obviously and doing demage to liver.