慢性肝病患者乙肝病毒血清学标志物转换规律及其意义

The regular pattern and significance of the transform of hepatitis B virus marks in patients with chronic hepatitis B

目的探讨乙肝病毒血清学标志物(HBVM)在慢性肝病患者中的转换规律及临床意义。方法选择慢性肝病患者包括慢性病毒性乙型肝炎、慢性重型乙型肝炎、肝炎肝硬化和原发性肝癌患者183例,采用ELISA方法对HBVM(HBsAg、HBsAb、HBeAg、HBeAb和HBcAb)进行检测,采用荧光定量聚酶链反应法进行HBV DNA检测,将HBV DNA检测值进行对数转换行统计学分析。结果慢性肝病患者的HBVM共有3种模式:大三阳(L3PP:HB-sAg、HBeAg和HBcAb)、小三阳(S3PP:HBsAg、HBeAb和HBcAb)和小二阳(S2PP:HBsAg和HBcAb)。L3PP HBVDNA水平高于S3PP和S2PP(P<0.01)。随着慢性肝病病情发展,L3PP阳性率呈下降趋势,S3PP和S2PP阳性率呈上升趋势(P均<0.01);不同临床类型的慢性肝病患者3种HBVM模式的分布存在统计学差异(P<0.01)。结论 L3PP慢性肝病患者HBV DNA复制水平高于S3PP或S2PP模式。随着慢性肝病病情的进展,HBVM的模式可发生转换,HBeAg阴转,L2PP转为S3PP或S2PP。

Objective To investigate the regular pattern and significance of the transform of hepatitis B virus marks in patients with chronic hepatitis B virus infection.Methods The peripheral blood was collected from 183 patients with chronic hepatic diseases related to hepatitis B virus infection,chronic severe hepatitis,cirrhosis and hepatocellular carcinoma.The marks of hepatitis B virus and HBV DNA were investigated by methods of ELISA and fluorescence quantitative polymerase chain reaction（FQ-PCR） techniques.The index numbers of HBV DNA were changed into constants by logarithm.Results There were three kind patterns of HBVM including large three positive pattern（L3PP： HBsAg,HBeAg,HBcAb）,small three positive pattern（S3PP： HBsAg,HBeAb,HBcAb） and small two positive pattern（S2PP： HBsAg,HBcAb）.The level of HBV DNA in the L3PP group was higher than that of S3PP and S2PP group（P0.01）.The positive rate decreased with the development of chronic hepatic diseases in L3PP group,while increased in S3PP and S2PP group（P0.01）.On the whole,there was significant difference of HBVM in different clinical types of chronic hepatitis B（P0.01）.Conclusion The level of HBV DNA in L3PP group was higher than that of S3PP and S2PP group.L3PP might be changed into S3PP or S2PP with the development of chronic hepatic diseases related to chronic hepatitis B virus infection,which indicates a negative change of HBeAg and a lower replication of HBV.