慢性乙型肝炎患者HBVDNA自发性下降的流行病学特点  

The epidemiological features of spontaneous decrease of HBV DNA level in chronic hepatitis B patients

作　　者：刘静[1] 邓子德[1] 吴跃[1] 谢俊强[1] 彭亮[1] 高志良[1] 

机构地区：[1]中山大学附属第三医院感染病科,广州510630

出　　处：《中华传染病杂志》2009年第4期228-233,共6页Chinese Journal of Infectious Diseases

摘　　要：目的了解HBVDNA水平自发性下降在慢性乙型肝炎（CHB）患者中的发生率、分布特征及其影响因素。方法应用临床流行病学调查方法研究315例CHB或肝硬化（LC）患者HBVDNA自发性下降的发生率、人口学特点及诊断分布情况，并采用Logistic回归分析HBVDNA自发性下降的影响因素。结果在12周内发生HBVDNA自发性下降的患者为171例，占54．3％，其中，HBVDNA降至31g拷贝／mL以下的患者为61例，占19．4％。分层研究显示青年组与少年组患者HBVDNA自发性下降率分别为58．6％（116／198例）和25．0％（2／8例），前者高于后者（X2=2．956，P=0．048）；病情重的比病情轻的患者更易发生HBVDNA自发性下降，两两比较，有差异组的均X2〉3．84，P〈0．05，其中慢性重型肝炎的下降率最高，达78．7％（48／61例）。重叠HEV感染与单纯HBV感染患者HBVDNA自发性下降率分别为75．0％（21／28例）和51．8％（146／282例），前者高于后者（X2=5．530，P=0．019）。ALT〉400U／L与ALT≤400U／L的患者HBVDNA自发性下降率分别为61．8％（102／165例）和46．0％（69／150例），前者高于后者（X2=7．922，P=0．005）；TBil〉200／1mol／L与TBil≤200μmol／L的患者HBVDNA自发性下降率分别为68．7％（79／115例）和46．0％（92／200例），前者高于后者（X2=15．155，P=0．000）。多因素Logistic回归分析显示，慢性重型肝炎、ALT〉400U／L、TBil〉200μmol／L是CHB或LC患者发生HBVDNA自发性下降的影响因素（均0R〉1，P〈0．05）。结论HBVDNA水平自发性下降是CHB或LC患者自然病程进展（免疫清除期）中的常见现象。患者病情严重、ALT高、TBil高，则易发生HBVDNA自发性下降。Objective To study the incidence and distribution features of spontaneous decrease of hepatitis B virus （HBV） DNA level and its correlative factors in chronic hepatitis B （CHB） patients. Methods The incidence, demographic features and distribution of different clinical types of spontaneous decrease of HBV DNA were investigated with clinical epidemiological study in 315 CHB or live cirrhosis （LC） patients. The correlative factors of spontaneous decrease of HBV DNA were analyzed by Logistic regression methods. Results Among the 315 patients, 171 patients （54.3%） underwent spontaneous decrease of HBV DNA within 12 weeks, of which 61 patients （19. 4%） had undetectable HBV DNA （〈3 1g copy/mL）. The stratified study showed that the incidence of spontaneous decrease of HBV DNA in young patients was 58.6% （116/198 cases）, which was higher than that （25.0%, 2/8 cases） in juvenile patients （Xz =2. 956, P=0.048）. The incidence of decrease in relatively more severe patients was higher than that in relatively less severe patients （all Z2 in significant groups〉3.84, all （48/61 cases） in patients with chronic severe hepatitis P〈0.05）, and the highest incidence was 78. 7% B. The incidence of spontaneous decrease of HBV DNA in hepatitis E virus （HEV）/HBV coinfected patients was 75.0% （21/28 cases）, which was higher than that （51.8%, 146/282 cases） in single HBV-infected patients （X2 =5. 530, P=0. 019）. The incidence of spontaneous decrease of HBV DNA in patients with alanire aminotransferase （ALT） 〉 400 U/L was 61.8% （102/165 cases）, which was higher than that （46.0%, 69/150 cases） in patients with ALT≤ 2 400 U/L （X2 =7. 922, P=0. 005）. The incidence of spontaneous decrease of HBV DNA in patients with TBil〉200 μmol/L was 68. 7% （79/115 cases）, which was higher than that （46.0%, 92/200 cases） in patients with TBil≤ 200 μmol/L （X2 = 15.155, P = 0. 000）. The multivariate Logistic analysis demonstrated that chronic severe hepatiti

关 键 词：肝炎 乙型 慢性 肝硬化 肝炎病毒 乙型 DNA 病毒 流行病学 

分 类 号：R512.62[医药卫生—内科学] R179[医药卫生—临床医学]