HBeAg阴性慢性乙型肝炎患者临床特点分析

Retrospective study on clinical characteristics of 373 patients with HBeAg-negative chronic hepatitis B

目的了解HBeAg阴性慢性乙型肝炎(Chronic hepatitis B,CHB)患者的临床特点,为优化防治方案提供依据。方法分析732例CHB及乙肝肝硬化(hepatitis B cirrhosis,HBC)患者的临床资料,根据HBeAg特点分为阴性组和阳性组,分析两组患者年龄、病程、病情、病毒学、病理组织学等方面的差异。结果阴性组373例(51%);阳性组359例(49%)。阴性组患者入院时平均年龄较阳性组大[(50.2±12.8)vs 38.8±13.1)岁,P<0.05],HBsAg阳性持续时间长[12.0(0.5,59.0)vs 6.0(0.5,48.0)年,P<0.05],血清HBVDNA载量低[1.01×104(<103,4.9×108)vs 1.30×106(<103,7.11×109)copies/ml,P<0.05]。两组患者血清HBsAg定量差异无统计学意义[3685(1,9090)vs 3530(2,10600)U/ml,P>0.05]。阴性组并发原发性肝癌的发生率较阳性组高(17.4%vs 6.69%,P<0.05)。结论在我院感染科住院的CHB和HBC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,病情较隐匿,血清HBVDNA载量较低,并发原发性肝癌多见。

Objective To investigate the clinical characteristics of HBeAg-negative chronic hepatitis B （CHB） and provide evidence for the prevention and treatment protocols.Methods Retrospective study was carried out on 732 cases of CHB and hepatitis B cirrhosis （HBC）.Patients were divided into HBeAg-negative group and HBeAg-positive group based on HBeAg status.Age,duration of disease and virological features were compared between the 2 groups.Results 373 patients （51%） were HBeAg negative and 359 （49%） were HBeAg positive.The mean age in HBeAg-negative group was （50.2±12.8） years,older than that in HBeAg-positive group which the mean age was （38.8±13.1） years （P〈0.05）.Duration of HBsAg positive in HBeAg-negative group was 12.0 years,longer than that in HBeAg-positive group 6.0 years （P〈0.05）.The median serum HBV DNA level in HBeAg-negative group was 1.01× 104 （〈103,4.9 ×108） copies/ml,lower than that in HBeAg-positive group [1.30 × 106 （〈103,7.11 × 109） copies/ml] （P〈0.05）.The median serum HBsAg levels were 3685 U/ml in HBeAg-negative group and 3530 U/ml in HBeAg-positive group,and the difference between them was not significant （P〉0.05）.About 17.4 % of HBeAg-negative patients developed primary liver cancer,and the proportion was higher than that of HBeAg-positive patients （6.69%） （P〈0.05）.Conclusion HBeAgnegative patients account for considerable proportion in the patients with CHB and HBV-related cirrhosis.They are much older,and have longer duration of disease,lower serum HBV DNA level,and more commonly develop into primary liver cancer.