乙型肝炎血清标志模式与病毒载量的关系及意义

The relationship between HB serum marker models and HBV load quantity and its clinical significance

为探讨乙型肝炎 (以下简称乙肝 )血清标志模式与病毒载量的关系及临床意义 ,作者选择符合 2 0 0 0年《全国病毒性肝炎诊断标准》的慢性肝炎血清 1343份 ,分别用ELISA法、PCR ELISA法检测HB血清标志、HBV -DNA和 1896位点变异株。结果显示 :HBsAg阳性血清 10 97份 (81.6 8%、)HBsAg阴性血清 2 4 6份 (81.31% )。在HBsAg阳性血清中 ,HBsAg、HBeAg、抗 HBc(1 3 5 )阳性组 4 0 4份 (30 .l% ) ,HBV -DNA阳性 347份 (85 .89% ) ,DNA阳性值呈递增趋势 (10 4～ 10 6拷贝 /ml,各占 8.6 5 %、33.71%、5 3.6 1% ) ;而HBsAg、抗 HBe阳性组血清 6 0 6份 (45 .12 % ) ,DNA阳性值 10 5拷贝 /ml,占优势 (6 4 .18% )。在HBsAg阴性血清中 ,抗 HBs、抗 HBe、抗 HBc(2 4 5 )阳性组 2 32份 (17.2 7% ) ,DNA阳性占 7.32 % ,DNA阳性值递减由 10 4～ 10 6拷贝 /ml,各占 5 2 .9%、4 1.l%、5 .9%。结论 ,各血清标志模式中的病毒载量为HBsAg阳性组 >HBsAg阴性组 ,阳性组 1 3 5 >1 4 5 >l 5 >2 4 5。但 1 3 5阳性组中 14 %在界值以下 ,1 4 5阳性组中 1896位点自然变异达 78.6 % ,2 4 5阳性组中仍存在DNA+ 血清 ,以上提示在临床判定和治疗时要慎重对待(注 :l=HBsAg,2 =抗 HBs,3=HBeAg ,4 =抗 HBe ,5 =抗 HBc)

To explore the relationship between the serum marker models of HB and the load quantity of HBV and its clinical significance,1 343 sera of chronic HB patients based on diagnostic standard of virus hepatitis,2000,were examined by ELISA for HB markers,and PCR-ELISA for HBV-DNA and variant of locus 1 896.The results showed:Among the total 1 097(8l.68%)cases of HBsAg positive,there were 404(30.l%)cases of 3-5 positive group[including 347(85.89%)of HBV-DNA positive],in which the trend of HBV-DNA quantity was rising gradually(8.65%,33.71% and 53.67% are ranged from 10 4 copies/ml to 10 6 copies/ml),and 606(45.12%)of positive group1-4-5(HBV-DNA +of 10 5 copies/ml occupying 64.18%).Among 246(18.31%)cases of HBSAg negative,there were 232(17.27%)case of positive group 2-4-5 occupying 7.32% of the total HBV-DNA positive(52.9%,41.1% and 5.9% are ranged from 10 4 copies/ml to 10 6 copies/ml). Gernerally conclusion, the HBV load quantity in the Serum of various marker model was that contained in HBsAg positive group is higher than that in HBsAg negative group,and the levels of that contained in following positive groups are in a such order:1-3-5(+)>1-4-5(+)>1-5(+)>2-4-5(+),but 14% of positive group 1-3-5 was lower than the diagnostic standard,78.6%of nature variation occurred at 1 896 locus in positive group1-4-5,and the positive HBV-DNA still occurred in positive group2-4-5.All above facts suggest that the HB cases should be treated cautiously for the clinical diagnosin and curing. (Not:1=HBsAg,2=anti-HBs,3=HBeAg,4=anti,HBe,5=anti-HBc)