慢性乙型肝炎患者血清与粪便HBV DNA水平对比研究

Comparative study of serum and fecal HBV DNA in patients with chronic hepatitis B

目的分析慢性乙型肝炎(CHB)患者血清和粪便HBV DNA与血生化指标和肠道菌群的相关性。方法 2015年8月～2017年3月在我院就诊的CHB患者73例,常规检测血生化、HBV标记物和HBV DNA水平,同时收集粪便,测量HBV DNA及双歧杆菌、乳酸杆菌、肠杆菌、肠球菌、梭菌属、白色念珠菌、拟杆菌、普雷沃氏菌、瘤胃球菌等9种肠道菌群DNA,比较血清和粪便HBV DNA与肝功能和肠道菌群DNA的相关性。结果 48例血清HBeAg阳性患者粪便和血清HBV DNA水平分别为(5.9±1.6) copies/ml和(7.2±1.6) copies/ml,均显著高于25例血清HBeAg阴性组的(5.0±1.9) copies/ml和(6.1±1.3) copies/ml (t=4.401,P=0.024;t=5.936,P=0.008);21例轻度、47例中度和5例重度CHB患者粪便和血清HBV DNA定量水平比较差异均无统计学意义(P>0.05);粪便HBV DNA与血清HBV DNA水平呈正相关(r=0.61,P=0.002),与血清ALP和TBIL水平呈负相关(r=-0.49,r=-0.54,P<0.05),而血清HBV DNA与血清ALT或AST水平呈负相关(r=-0.46,P=0.023;r=-0.52,P=0.008);粪便HBV DNA与肠球菌呈正相关(r=0.49,P=0.005),而血清HBV DNA与乳酸杆菌呈负相关(r=-0.53,P<0.001),其余肠道菌群与HBV DNA无明显相关性(P>0.05)。结论 CHB患者粪便存在HBV DNA,其检测的意义还有待于进一步探讨。

Objective To analyze the correlation between serum and fecal HBV DNA and biochemical indexes and intestinal flora in patients with chronic hepatitis B(CHB).Methods 73 patients with CHB were recruited in our hospital between August 2015 and March 2017,and liver function index,serum HBV markers and HBV DNA were detected.Besides,fecal HBV DNA and Bifidobacterium,Lactobacillus,Escherichia Coli,Enterococcus,Clostridium,Candida albicans,Bacteroides,Poulet,Rumen bacteria aureus in intestinal flora were assayed.The correlation between serum and fecal HBV DNA,and liver function index and intestinal flora DNA were compared.Results Fecal and serum HBV DNA levels in 48 patients with serum HBeAg positive were(5.9±1.6)copies/ml and(7.2±1.6)copies/ml,respectively,much higher than(5.0±1.9)copies/ml and(6.1±1.3)copies/ml(t=4.401,P=0.024;t=5.936,P=0.008)in 25 patients with serum HBeAg negative;there were no significant differences as respect to serum and fecal HBV DNA levels among 21,47 and 5 patients with mild,moderate and severe hepatitis B(P>0.05);the fecal HBV DNA level was positively correlated to serum HBV DNA(r=0.61,P=0.002);fecal HBV DNA was negatively correlated serum ALP and TBIL(r=-0.49,r=-0.54,P<0.05),and serum HBV DNA load was negatively correlated to serum ALT and AST levels(r=-0.46,P=0.023;r=-0.52,P=0.008);Fecal HBV DNA level was positively correlated to fecal enterococci(r=0.49,P=0.005)and serum HBV DNA was negatively correlated with lactobacillus(r=-0.53,P<0.001).Conclusion The fecal HBV DNA is positive in patients with CHB,which warrants further investigation.