失代偿期乙型肝炎肝硬化患者血清HBV-DNA水平与生化及凝血等指标相关性分析

A Correlation Analysis Between Serum HBV-DNA Level and Biochemistry and Coagulation Indexes in Patients with Decompensated Hepatitis B Cirrhosis

目的分析失代偿期乙型肝炎肝硬化患者血清HBV-DNA水平与乙型肝炎病毒标志物、生化及凝血等指标的相关性。方法回顾性分析2018年1月至2020年12月我院收治的645例失代偿期乙型肝炎肝硬化患者的临床资料,根据HBV-DNA水平分为4组:阴性组、低病毒载量组(<2.0×10^(3)IU/mL)、中病毒载量组(2.0×10^(3)~2.0×10^(5)IU/mL)和高病毒载量组(>105IU/mL),测定所有患者乙型肝炎病毒血清学标志物(HBV-M)、肝功能相关生化指标(ALT、AST、TBIL、DBIL、ALB)、凝血相关指标(PT、INR、APTT、TT、D-D、PLT),比较4组患者各项指标的差异,并分析各项指标与HBV-DNA水平的相关性。结果在失代偿期乙型肝炎肝硬化患者中,HBsAg和HBeAg的定量数值随着HBV-DNA水平的升高而增高,HBsAg的明显升高主要体现在HBV-DNA阴性组和低病毒载量组之间(779.40 vs 5773.00IU/mL),而HBeAg的表达在中病毒载量组(0.19 COI)和高病毒载量组(7.96 COI)中才出现显著升高,低病毒载量组的HBeAg阳性表达率较低。随着病毒载量的升高,患者的ALT、AST、TBIL、DBIL、D/T、AFP指标均有所升高,而ALB的水平降低;除TT存在显著性差异外,PT、APTT、INR、Fib、D-D、PLT这6个指标差异均无统计学意义。经Pearson相关性分析检验,失代偿期乙型肝炎肝硬化患者血清HBV-DNA水平与ALT、AST、TBIL、DBIL、AFP、PT、APTT、TT、D-D、HBsAg、HBeAg水平呈正相关(r>0,P均<0.05),与ALB、Fib水平呈负相关(r<0,P均<0.05),与PLT、HBeAb水平不存在相关性。结论在失代偿期乙型肝炎肝硬化患者中,血清HBV-DNA载量与HBsAg、HBeAg表达水平密切相关,与ALT、AST、TBIL、DBIL、D/T、ALB等肝功能相关生化指标相关,与凝血相关指标存在关联,但在不同HBV-DNA载量组中无差异。HBV-DNA载量可作为HBeAg阴性患者肝脏损害程度的有效预测指标。

Objective To analyze the correlation between serum HBV-DNA level and hepatitis B virus markers,biochemical and coagulation indexes in patients with decompensated hepatitis B cirrhosis.Methods The clinical data of 645 patients with decompensated hepatitis B cirrhosis admitted to our hospital were analyzed retrospectively from January,2018 to December,2020.According to the level of HBV-DNA,these patients were divided into four groups:negative group,low viral load group(<2.0×10^(3)IU/mL),medium viral load group(2.0×10^(3)-2.0×10^(5)IU/mL),and high viral load group(>105IU/mL).Hepatitis B virus serum markers(HBV-M),liver function related biochemical indexes(ALT,AST,TBIL,DBIL,ALB),coagulation related indexes(PT,INR,APTT,TT,D-D,PLT)were measured in all patients.The differences of various indexes in the four groups were evaluated,and the correlation between various markers and the level of HBV-DNA was analyzed.Results In patients with decompensated hepatitis B cirrhosis,the quantitative values of HBsAg and HBeAg elevated with the increase of HBV-DNA level.The significant increase of HBsAg expression was mainly between the HBV-DNA negative group and the low viral load group(779.40 vs 5773.00 IU/mL),while the expression of HBeAg was significantly increased in the medium viral load group(0.19 COI)and the high viral load group(7.96 COI).Positive expression rate of HBeAg in the low viral load group was lower than that in other groups.With the increase of viral load of the patients,levels of ALT,AST,TBIL,DBIL,D/T and AFP increased,while the level of ALB decreased;Except for TT,there was no significant difference in PT,APTT,INR,Fib,D-D and PLT.Pearson correlation analysis showed that serum HBV-DNA level was positively correlated with levels of ALT,AST,TBIL,DBIL,AFP,PT,APTT,TT,D-D,HBsAg,and HBeAg,while negatively correlated with ALB and Fib.Nevertheless,HBV-DNA level showed no correlation with levels of PLT and HBeAb in patients with decompensated hepatitis B cirrhosis.Conclusion In patients with decompensated hepatitis B cirrhosis,serum HBV-DNA load is closely related to the expression level of HBsAg and HBeAg,and is related to the biochemical indicators related to liver function such as ALT,AST,TBIL,DBIL,D/T,and ALB.As to coagulation-related indicators,HBV-DNA load shows a correlation with indicators but with no differences between different HBV-DNA load groups.HBV-DNA load can be used as an effective predictor of liver damage in HBeAg-negative patients.