HBeAg阴性的慢性HBV感染者HBV DNA与肝组织病理的关系

Relationship between HBV DNA level and pathological changes of liver tissue in HBeAg-negative patients with chronic HBV infection

目的分析HBeAg阴性、ALT正常的HBV感染者HBV DNA水平与肝组织病理的关系。方法 89例HBeAg阴性慢性HBV感染者均接受肝组织穿刺病理学检查,并行肝炎病毒标志物、血清HBV标志物和HBV DNA检测,分析其HBV DNA水平与肝组织病理的关系。组间比较采用单因素方差分析,相关性分析采用Spearman等级相关。结果 89例患者的肝组织病理结果大部分异常,其中肝组织炎症分级≥G2者70例,占78.6%;纤维化分期≥S2者66例,占74.2%。不同肝组织炎症活动度分级患者之间的HBV DNA定量有明显的差别(F=2.678,P<0.05),而且二者呈正相关(rs=0.327,P<0.01);不同肝纤维化分期患者之间的HBV DNA定量也有明显的差别(F=2.625,P<0.05),而且二者呈正相关(rs=0.314,P<0.01)。结论 HBeAg阴性的慢性HBV感染者血清HBV DNA定量与肝组织病理损伤程度具有良好的一致性,如HBeAg阴性慢性HBV感染者HBV DNA滴度明显升高,应及早进行肝脏穿刺病理检查,以明确诊断并指导抗病毒治疗。

Objective To analyze the relationship between hepatitis B virus （HBV） DNA level and pathological changes of liver tissue in HBeAg - negative patients with chronic HBV infection. Methods Eighty - nine HBeAg - negative patients with chronic HBV infection underwent liver biopsy and quantification of hepatitis virus markers, HBV markers, and HBV DNA in serum. The relationship between HBV DNA level and pathological changes of liver tissue was analyzed. One - way analysis of variance was used for comparison between groups; the Spearman rank correlation test was used for correlation analysis. Results Most of the 89 patients had abnormal liver pathology ; of all patients,70 （78.6%） had grade ≥2 liver tissue inflammation, and 66 （74. 2% ） had stage ≥2 liver fibrosis. There were significant differences in HBV DNA level among patients with different grades of liver tissue inflammation （ F = 2. 678, P 〈 0. 05 ）, and HBV DNA level was positively correlated with the grade of liver tissue inflammation （rs =0. 327, P 〈0. 01 ）. There were significant differences in HBV DNA level among patients with different stages of liver fibrosis （ F = 2. 625, P 〈 0. 05 ）, and HBV DNA level was positively correlated with the stage of liver fibrosis （ rs = 0. 314, P 〈 0. 01 ）. Conclusion There is a positive correlation between serum HBV DNA level and the degree of pathological damage of liver tissue in HBeAg -negative patients with chronic HBV infection. For the HBeAg -negative patients with chronic HBV infection who have significantly elevated HBV DNA level, liver biopsy should be performed in time for confirmed diagnosis and antiviral therapy.