慢性乙型肝炎病例乙型肝炎病毒脱氧核糖核酸载量和乙型肝炎病毒e抗原状态与丙氨酸氨基转移酶的相关性研究

Study of the Relationship between Hepatitis B Virus Deoxyribonucleic Acid,Hepatitis B Virus e Antigen and Alanine Aminotransferase in Chronic Hepatitis B Patients

目的研究慢性乙型肝炎（乙肝）病例（Chronic Hepatitis B Patient,CHBP）乙肝病毒（Hepatitis B Virus,HBV）复制、乙肝病毒e抗原（HBV e Antigen,HBeAg）状态与丙氨酸氨基转移酶（Alanine Aminotransferase,ALT）检测值之间的相关关系。方法对31个省（自治区、直辖市）发现的确诊CHBP采血,检测肝功能和HBV感染血清学标志物[乙肝病毒表面抗原（HBV Surface Antigen,HBsAg）、HBeAg]及乙肝病毒脱氧核糖核酸（HBV Deoxyribonucleic Acid,DNA）载量。ALT指标在采血24h内由当地医疗机构检测。HBsAg、HBeAg及HBV DNA载量检测由中国疾病预防控制中心病毒病预防控制所统一完成。HBsAg、HBeAg使用美国雅培（Abbott）试剂光化学发光微粒子免疫分析法（Chemiluminesent Microparticle Immunoassay,CMIA）检测。HBV DNA载量使用实时聚合酶链反应（Polymerase Chain Reaction,PCR）工具包（中国复星医药有限公司）检测。结果 〈20岁、20~40岁和〉40岁CHBP中,高病毒载量[HBV DNA〉105拷贝/毫升（Copies/ml）]者比例分别为70.21%、40.37%和28.75%（χ2=29.38,P〈0.001）。在HBV DNA低（〈103Copies/ml）、中（103~105Copies/ml）、高（〉105Copies/ml）载量组内,HBeAg阳性率分别为2.36%、9.40%和82.24%,两两差异均有统计学意义（χ2=5.57,P=0.02;χ2=177.78,P〈0.001;χ2=140.31,P〈0.001）。多因素分析结果显示,影响CHBP ALT的独立因素有年龄、性别和HBV DNA载量。相对于0~19岁CHBP,20~39岁CHBP ALT升高比值比（Odds Rate,OR）=3.27[95%可信区间（Confidence Interval,CI）：1.32~8.01],〉40岁CHBP ALT升高OR=3.92（95%CI：1.54~9.98）。相对于女性,男性CHBP ALT升高OR=2.93（95%CI：1.64~5.24）。中病毒载量和低病毒载量对CHBP ALT的影响差异无统计学意义（χ2=0.20,P=0.66）,但高病毒载量组ALT升高的OR=3.01（95%CI：1.33~6.80）。结论 HBeAg阳性CHBP体内HBV复制活跃,HBV DNA高病毒载量是CHBP ALT升高的危险因素。

Objective To analyze the relationship among replication of hepatitis B virus （HBV）deoxyribonucleic acid（DNA）, HBV e antigen（HBeAg） status, and alaninea minotransferase （ALT） elevation in chronic hepatitis B patients（CHBP）. Method Blood samples were collected from CHBP in the 31 provinces, andtested for HBV infection sero-markers [ HBV surface antigen （HBsAg） and HBeAg, HBV DNA and ALT]. ALT was tested by the local hospitals within 24 hours after the blood samples were collected. HBsAg, HBeAg and HBV DNA tests were conducted by the National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention. A chemiluminesent microparticle immunoassay （abbott laboratories, USA） wasused. HBV DNA levels were detected by use of real-time polymerase chain reaction （PCR） （Fosun Pharmaceutical Co., China）. Results The percentages of CHBP with high HBV DNA loads （ 〉 10%opies/ml） by age group （ 〈20 years, 20 -40 years and 〉40 years） were 70. 21%, 40. 37% and 28. 75%, respectively （X2 =29. 38 ,P 〈0. 001 ）. HBeAg positivity rates by three HBV DNA levels （ 〈 103copies/ml, 103 - 105copies/ ml, and 〉 105copies/mt） were 2. 36%, 9. 40% and 82. 24% respectively, and the differences were statistically significant between each two-group pairings （X2 = 5.57, P = 0. 02; X2 = 177. 78, P 〈 0. 001 ; X2 = 140. 31, P 〈0. 001 ）. Multiple factor analysis showed that age, gender, and HBV DNA load were independent risk factors for ALT elevation in CHBP. Compared with the 0 - 19 year old age group, the 20 - 39 year old age group patients＇odds ratio （OR） for ALT elevation was 3. 27 [95% confidence interval （（21：1.32 -8. 01 l, and for the 〉40 year old age group, the OR was 3. 92（95%CI： 1.54 -9. 98）. Compared with female patients, male chronic hepatitis B patients＇ ALT elevation OR was 2. 93 （95% CI： 1.64 - 5. 24）. There was no significant difference in ALT elevation by HBV DNA load between the 103 -10%opies/ml group and the 〈 103copies/ml group（x2 =0. 20,P =O. 66）. However, in the HBV DNA 〉 10Scopies/ml group, the OR for ALT elevation was 3.01 （95% CI： 1.33 -6. 80）. Conclusions HBV replication was greatest in HBeAg positive CHBP, and high HBV DNA load was a risk factor for ALT elevation.