乙型肝炎e抗原阴性与阳性慢性重型乙型肝炎临床分析  

The clinical features of chronic severe hepatitis B with negative hepatitis B e-antigen and positive hepatitis B e-antigen.

作　　者：何华[1] 曾维群[1] 刘毅[1] 石小枫[1] 张大志[1] 

机构地区：[1]重庆医科大学附属第二医院感染病科教育部感染性疾病分子生物学重点实验室,重庆400010

出　　处：《中国实用内科杂志》2009年第5期450-452,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的分析乙型肝炎e抗原(HBeAg)阴性与HBeAg阳性慢性重型乙型肝炎患者的临床特点。方法2001年1月至2006年9月在重庆医科大学附属二医院收治的353例慢性重型乙型肝炎患者分为HBeAg阴性组236例(66.8%),HBeAg阳性组117例(33.2%),HBeAg阴性患者平均年龄高于HBeAg阳性患者,分别为(43.5±12.4)岁和(40.8±11.3)岁,两组比较差异有统计学意义(t=-1.988,P=0.048)。对两组生化指标、HBV DNA、肝硬化基础、并发症、预后等进行分析。结果HBeAg阴性患者血清HBV DNA低于HBeAg阳性患者,分别为(5.49±2.02)log10拷贝/mL、(6.64±1.41)log10拷贝/mL,两组比较差异有统计学意义(t=6.46,P<0.001);且HBeAg阴性患者血清HBV DNA<5 log10拷贝/mL的病例数比例为41.8%,远高于HBeAg阳性患者(11.9%),两组比较差异有统计学意义(χ2=30.055,P<0.001)。两组在肝脏生化指标、肝硬化基础及发生感染、腹水、肝性脑病、消化道出血等并发症及近期预后方面比较,差异均无统计学意义。结论HBeAg阴性患者血清HBV DNA低于HBeAg阳性患者。HBeAg阴性慢性重型肝炎的肝脏生化指标、并发症发生率及近期预后与HBeAg阳性的慢性重型肝炎相似。应重视低水平病毒复制的HBeAg阴性慢性乙型肝炎患者的治疗、随访,早期抗病毒治疗,减少重型肝炎的发生率。Objective To study the clinical features of chronic severe hepatitis B with negative hepatitis B e-antigen （HBeAg）and positive hepatitis B e-antigen（HBeAg）. Methods A total of 353 in-patients with chronic severe hepatitis B from the second affiliated hospital of Chongqing Medical University were recruited into the study and divided into two groups according to the HBeAg status. Of the 353 in-patients ,236 （66. 8% ） patients were HBeAg-negative, 117 （ 33. 2% ） patients were HBeAg-positive. The average age of HBeAg-negative patients was older than that of HBeAg-positive patients [ （43.5 ± 12. 4 ） y and （40. 8 ± 11.3 ） y respectively,P = 0. 048 ]. The serological chemistry data, hepatitis B virus （ HBV ） DNA quantification data were detected, and morbility of cirrhosis, its eomplieations and prognosis were also studied. Results The serum HBV DNA level of HBeAg-negative patients was significantly lower than that of HBeAg-positive patients [ （5.49 ± 2. 02） logl0 copies/mL vs（6. 64± 1.41 ） log10 eopies/mL,P 〈 0.01 ]. The ratio of patients who had a serum HBV DNA level less than 5 log10 eopies/mL in HBeAg-negative patients was significantly higher than that in HBeAg-pesitire patients （41.8% vs 11.9% , P 〈 0. 001 ）. There was no significant difference in serological chemistry data, morbility of cirrhosis and its complications on infections, aseites, hepatoencephalopathy, gastrointestinal hemorrhage, as well as prognosis of the patients between those two groups. Conclusion This study suggested that serological chemistry data,morbility of complications and prognosis of the disease of HBeAg-negative patients resemble those of HBeAg-positive patients. The HBeAg-negative patients had a higher level of age, while a lower level of serum HBV DNA. To reduce the ineidence of liver failure, more frequent monitoring and earlier antiviral therapy prone to be reasonable for chronic hepatitis B patients with negative hepatitis B e-antigen（HBeAg）.

关 键 词：乙型肝炎 重型肝炎 

分 类 号：R5[医药卫生—内科学]