HBeAg阴性与阳性慢性乙型肝炎患者的临床病理比较研究  

Clinical features and pathological changes in HBeAgnegative chronic hepatitis B patients and HBeAg-positive ones

作　　者：祖可佳[1] 张立洁[1] 孟欣[1] 王欣欣[1] 孙琳[1] 张世杰[1] 宋晨朝[1] 汤宏[1] 金荣华[1] 赵景民[2] 

机构地区：[1]首都医科大学附属北京佑安医院,北京100069 [2]解放军第三○二医院,北京100039

出　　处：《传染病信息》2008年第5期280-283,共4页Infectious Disease Information

基　　金：北京市科技计划重大项目资助(H020920020290)

摘　　要：目的探讨HBeAg阴性和HBeAg阳性慢性乙型肝炎患者的临床病理学差异。方法选择2008年01—05月在北京佑安医院住院并作活体肝组织穿刺病理学诊断(肝穿)且诊断为慢性乙型肝炎的患者137例,其中HBeAg(+)组87例,HBeAg(-)组50例,对2组间的血清学指标及肝穿病理结果进行对比分析。结果①HBeAg(+)组和HBeAg(-)组HBV DNA阳性率比较有统计学差异(P=0.000 0);②HBeAg(+)组患者的ALT异常率要高于HBeAg(-)组,差异具有统计学意义(P=0.023);③HBeAg(+)组的病理炎症分级要重于HBeAg(-)组,差异具有统计学意义(P=0.0021),但2组间纤维化程度差异无统计学意义(P>0.05);④HBeAg(-)组中HBVDNA(+)组的病理炎症分级要重于HBVDNA(-)组,差异有统计学意义(P=0.007),但2组间纤维化程度差异没有统计学意义(P>0.05)。结论血清HBeAg阳性是判断HBV复制的良好指标。对HBeAg阴性患者应常规测定血清HBV DNA水平,筛查前C区变异。尤其应对HBeAg阴性且HBV DNA高水平的患者加以重视,结合肝穿结果综合评估病情以指导临床诊疗。Objective To investigate the differences in liver pathological changes and clinical features between HBeAg-negative and HBeAg-positive chronic hepatitis B patients. Methods A total of 137 patients with chronic hepatitis B, who were admitted to Beijing You＇an Hospital and received liver biopsy during January and May 2008, were included in this study. They were divided into two groups, HBeAg-positive group （87 cases） and HBeAg-negative group （50 cases）. Serum indices and the pathological changes of liver fine needle aspiration biopsy were compared and analyzed between the two groups. Results HBV DNA-positive rate was significantly higher in HBeAg-positive group than that in HBeAg-negative group （P=0.000 0）. HBeAg-positive group had significantly higher serum ALT abnormality rate than HBeAg-negative group （P=0.023）. Inflammatory grade in patients of HBeAg-positive group appeared to be more severe than that in patients of HBeAg-negative group （P=0.002 1）. There were no significant differences in fibrosis staging between the two groups （P〉0.05）. For HbeAg-negative group, patients with HBV DNA positive had more severe inflammatory grade than those with HBV DNA negative （P=0.007）, howerver, there were no significant differences in fibrosis staging between HBV DNA-positive and HBV DNA-negative patients （P〉0.05）. Conclusion Serum HBeAg positive represents HBV replication. The routine procedures should be made in HBeAg-negative patients, involving the detection of serum HBV DNA levels and the screening of pre-C mutation. HBeAg-negative patients with high level of HBV DNA should be paid more attention, comprehensively evaluating their conditions based on pathological findings of liver biopsy so as to guide clinical diagnosis and treatment.

关 键 词：慢性乙型肝炎 HBEAG HBV DNA 肝活体组织 病理 

分 类 号：R512.62[医药卫生—内科学]