慢性HBV感染者血清HBeAg、HBV DNA载量与肝组织病理损伤的关系

Relationship between serum expression of HBeAg,HBV DNA level and hepatic pathologic impairment of patients with chronic hepatitis B virus infection

目的对比不同年龄阶段乙型肝炎e抗原(HBeAg)阳性及HBeAg阴性慢性乙型肝炎病毒(HBV)感染者的肝脏病理特点。方法 323例慢性HBV感染者分为HBeAg阳性组与HBeAg阴性组,每组以40岁为界分为高龄组与低龄组,均经肝穿刺活组织检查,同时检测血清丙氨酸氨基转移酶(ALT)、HBV DNA,分析HBeAg阳性与HBeAg阴性患者高龄组与低龄组的肝脏病理损伤与血清ALT及HBV DNA水平的关系。结果 HBeAg阳性高龄组与HBeAg阴性高龄组比较具有更明显的炎症程度(P<0.05)及更高的HBV DNA载量(P<0.01),HBeAg阳性低龄组与HBeAg阴性低龄组比较HBV DNA载量较高(P<0.01),但炎症程度无明显差异(P>0.05)。HBeAg阴性非活动性HBV携带者与HBeAg阴性慢性乙型肝炎患者肝脏病理炎症、纤维化程度及血清HBV DNA水平在高龄组差异有统计学意义(P<0.01),而在低龄组差异无统计学意义。结论慢性HBV感染者血清HBeAg表达和HBV DNA水平与肝组织病理炎症分级的关系在不同年龄阶段表现不同,血清HBeAg表达与否和HBV DNA水平高低不能单独作为判断肝组织病理变化程度的指标。

Objective To compare the pathological characteristics at different age-stage in HBeAg-positive patients and HBeAg-negative patients with chronic hepatitis virus（HBV）infection.Methods Three hundred and twenty-three cases with chronic HBV infection were divided into HBeAg-positive group and HBeAg-negative group.Patients in each group were further divided in age-based subgroups（age〈40,goung;age≥40,old）.Liver biopsy was performed in all cases.The grade and the stage of the liver tissues were routinely obtained.The levels of alanine aminotransferase and HBV DNA were simultaneously measured.The relation of ALT level,HBV DNA level and the pathological characteristics were analyzed in all four subgroups.Results The grade of liver inflammation and the HBV DNA level in HBeAg-positive old patients was significantly higher than that in HBeAg-negative patients.There was no significant difference between HBeAg-positive young patients and HBeAg-negative patients,although the HBV DNA level in the HBeAg-positive young patients was higher than that in HBeAg-negative patients.The grade of liver inflammation and stage of liver fibrosis were significantly different between old HBeAg-negative inactive carrier and HBeAg-negative chronic hepatitis B patients.Similarly there was no significant difference in young patients.The HBV DNA level in HBeAg-negative chronic hepatitis B patients was significantly higher than that in HBeAg-negative inactive carrier.Conclusion The relationships between serum HBeAg expression,HBV DNA levels and the grade of liver inflammation varied in different age stages.HBeAg expression and HBV DNA level could not be used as independent factors to evaluate liver the severity of liver impairment in patients with chronic hepatitis B virus infection.