HBeAg阴性慢性乙型肝炎和乙型肝炎肝硬化临床特点分析

Clinical features of patients with HBeAg-negative chronic hepatitis B and HBV-related cirrhosis

目的了解HBeAg阴性慢性乙型肝炎(乙肝)及乙肝肝硬化患者的临床特点,为防治方案的制定提供依据。方法回顾性分析673例于我科住院的慢性乙肝及乙肝肝硬化患者临床资料,根据HBeAg特点分为阴性组和阳性组,分析2组患者年龄、病程、病毒学等方面的异同。结果阴性组352例,占52.3%;阳性组321例,占47.7%。阴性组患者入院时平均年龄较阳性组患者大[(51.2±13.0)、(40.8±14.1)岁,P=0.000]、HBsAg阳性持续时间长[12.0(0.5,59.0)、6.0(0.5,48.0)年,P=0.000]、血清HBVDNA载量低[1.01菖10(4<103,4.91菖108)、1.30菖10(6<103,7.11菖109)copies/ml,P=0.000],2组患者血清HBsAg定量差异无统计学意义[3685(1,9090)和3530(2,10600)U/ml,P=0.271]。阴性组并发原发性肝癌的发生率较HBeAg阳性组高(20.5%和8.7%,P=0.000)。结论在我科住院的慢性乙肝和乙肝肝硬化患者中,HBeAg阴性患者占相当的比例,HBeAg阴性患者年龄大、病史长、血清HBVDNA载量较低,并发原发性肝癌多见。

Objective To investigate clinical features of patients with HBeAg-negative chronic hepatitis B （CHB） and HBV- related cirrhosis and to provide evidence for the prevention and treatment protocols. Methods A retrospective study was conducted on 673 inpatients with CHB and HBV-related cirrhosis, who were treated in our department. According to HBeAg status, all the pa- tients were divided into 2 groups, HBeAg-negative group and HBeAg-positive group. Age, duration of disease and virological features were compared between the 2 groups. Results A total of 352 patients （52.3%） were HBeAg negative and 321 （47.7%） were HBeAg positive. The mean age in HBeAg-negative group was （51.2±13.0） years old, older than that in HBeAg-positive group [（40.8±14.1） years old] when they were admitted to hospital （P=0.000）. The duration of HBsAg positive in HBeAg-negative group was 12.0 （0.5, 59.0） years, longer than that in HBeAg-positive group [6.0 （0.5, 48.0） years] （P=-0.000）. The median serum HBV DNA level in HBeAg-neg- ative group was 1.01×10^4 （〈103, 4.91×10^8） copies/ml, lower than that in HBeAg-positive group [1.30×10^6 （〈10^3, 7.11 ×10^9） copies/m1] （P=-0.000）. The median serum HBsAg levels were 3685 （1, 9090） U/ml in HBcAg-negative group and 3530 （2, 10 600） U/ml in HBeAg- positive group, and the difference between them was not significant （P=0.271）. About 20.5% of HBeAg-negative patients developed primary liver cancer, and the proporation was higher than that of HBeAg-positive patients （8.7%） （P=0.000）. Conclusions of patients with CHB and HBV-related cirrhosis admitted to our hospital, HBeAg-negative patients account for a substantial proportion. They are much older, have longer duration of disease and lower serum HBV DNA level, and more commonly develop primary liver cancer.