乙型肝炎患者血清中乙肝病毒大蛋白检测及临床意义

Detection of Large Surface Proteins of HBV in Patients with Hepatitis B

目的探讨乙型肝炎病毒大蛋白(LHBs)的检测及对判定病毒复制情况以及抗病毒治疗的临床意义。方法选取保定市传染病医院573例乙肝患者,应用酶联免疫吸附试验(ELISA)检测血清中的LHBs、HBVM,应用实时定量荧光PCR方法检测HBV DNA水平;同时,通过随访研究,观察78例阿德福韦抗病毒治疗后患者LHBs与HBV DNA水平的关系。结果HBeAg阴性及阳性组的乙肝患者中,HBV DNA的阳性检出率与LHBs的阳性率差异均不具统计学意义;②抗病毒治疗患者HBVDNA和LHBs均呈下降趋势,但是LHBs的消减晚于HBVDNA;③抗病毒治疗过程中,乙型肝炎病毒人蛋白持续阳性组的HBV DNA阴转率低于LHBs阴转组(抗病毒治疗18个月LHBs持续阳性的患者比12个月时LHBs阳性的患者,继续接受治疗后DNA阴转的概率降低56%。结论LHBs能够反映HBeAg阴性乙肝患者病毒复制的水平,是HBV M检测的有益的补充;抗病毒治疗过程中LHBs和HBV DNA下降的趋势一致,抗病毒治疗过程中LHBs持续阳性者,HBV DNA出现阴转的概率降低,联合检测LHBs和HBV DNA对抗病毒治疗监测具有重要临床意义。

[ Objective ] To explore the detection of large surface proteins of hepatitis B （ LHBs ） and its clinical significance in viral replication judgment and antiviral therapy. [ Methods] A total of 573 cases of hepatitis Bin Baoding Hospital for Infectious Diseases were selected. ELISA was adopted-to detect serum LHBs and HBVM; real-time fluorescence PCR was applied to detect HBV DNA levels; through follow-up investigation on 78 cases which received Adefovir anti-viral therapy, the relationship between LHBs and HBV DNA level was observed. [ Results] The positive detection rate of HBV DNA and the positive rate of LHBs were not significantly different between hepatitis B patients with HBeAg negative and HBeAg positive. （2）HBV DNA and the LHBs showed declining trend in patients with anti-viral therapy, but the LHBs abated later than HBV DNA. （3） In the anti-viral treatment process, the rates of HBV DNA negative conversion in LHBs continuous positive group were less than that of LHBs negative conversion group { Compared with LHBs positive patients with anti-viral therapy for 12 months, the HBV DNA negative conversion rate in LHBs sustained positive patients with anti-viral therapy for 18 months reduced 56% }. [ Conclusion] LHBs can reflect the level of HBV replication in HBeAg negative patients, which is a useful complementary for detection of HBV M ; during the anti-viral therapy, the downdraughts of LHBs and HBV DNA are consistent, the proportion of HBV DNA negative conversion appears to reduce in patients with continuous LHBs positive. The combined detection of LHBs and HBV DNA is clinically significant in monitoring of antiretroviral therapy.