慢性乙型肝炎抗病毒疗效与外周血单个核细胞内乙型肝炎病毒DNA水平的关系  

The association of hepatitis B virus DNA levels in the peripheral blood mononuclear cell with antiviral efficacy in chronic hepatitis B

作　　者：杜以真[1] 张纵[1] 徐皖苏[1] 张孝国[1] 范桂玲[1] 蒋雪梅[1] 

机构地区：[1]济南市传染病医院肝病科,250021

出　　处：《中华传染病杂志》2011年第3期158-163,共6页Chinese Journal of Infectious Diseases

摘　　要：目的探讨慢性乙型肝炎（CHB）抗病毒疗效与达到停药标准时外周血单个核细胞（PBMC）内HBV DNA水平的关系。方法入选90例经抗病毒治疗达到停药标准的CHB患者，其中应用IFN44例，应用核苷类药物46例。所有患者均于停药时检测PBMC内HBV DNA，比较阴性组和阳性组治疗前血清HBV DNA水平与达到停药标准时PBMC内HBV DNA的关系，观察停药时PBMC内HBV DNA水平与复发的关系。计量资料采用t检验，计数资料采用X^2检验。结果90例CHB患者停药时，PBMC内HBV DNA阴性组67例，阳性组23例。CHB患者血清HBV DNA阳转率在PBMC内HBV DNA阴性组为13．4％（9／67例），显著低于阳性组的73．9％（17／23例），差异有统计学意义（X^2=30．4873，P〈0．01）。PBMC内HBV DNA阴性组与阳性组在肝病复发ALT升高幅度（t=0．8729，P=0．3913）、停药后复发时间（t=1．9222，P=0．0665）均差异无统计学意义，而在血清HBV DNA反弹幅度则差异有统计学意义（t=2．7493，P=0．0112）。5例患者获得HBsAg血清学转换，且均未检测到PBMC内HBVDNA，随访6～12个月无一例复发。PBMC内HBV DNA阳性组治疗前血清HBVDNA水平为（7．2±1.1）lg拷贝／mL，显著高于阴性组的（5．2±2．1）lg拷贝／mL（t=4．3557，P〈0．01）。结论经抗病毒治疗达到停药标准的CHB患者，其停药时的PBMC内HBVDNA水平可能是预测抗病毒疗效持久性的重要因素之一。Objective To explore the relationship between the antiviral effect and peripheral blood mononuclear cell （PBMC） hepatitis B virus （HBV） DNA when the patients reach the standard of withdrawal of antiviral therapy in chronic hepatitis B （CHB）. Methods Ninety CHB patients treated with interferon （n=44） or nucleot（s）ide （n 46） who reached the standard of withdrawal of antiviral therapy were recruited. HBV DNA levels in PBMCs were tested at the end of treatment, and its relationship with serum HBV DNA level before treatment in PBMC HBV DNA positive group and negative group were compared. The correlation between HBV DNA in PBMCs at the end of treatment and relapse were explored. Measurement data were analyzed by student t test and enumeration data X2 were analyzed by test. Results Among 90 patients, 67（74.4%） were PBMC HBV DNA negative at the end of treatment, and 23 （25. 6%） were positive. The serum HBV DNA positive conversion rate in PBMC HBV DNA negative patients was 13.4%, which were significantly lower than that in positive group （73.9%） （X^2 = 30. 4873, P〈0.01）. There were no significant differences of alanine aminotransferase （ALT） levels when hepatitis flare （t=0. 8729, P=0. 3913） and relapse time （t=1. 9222, P=0. 0665） between PBMC HBV DNA negative group and positive group after withdrawal of therapy, while the serum HBV DNA rebound was greater in positive group than that in negative group （t= 2. 7493, P=0. 0112）. There were five patients who achieved hepatitis B surface antigen （HBsAg） seroconversion, whose PBMC HBV DNA were all undetectable, and none relapsed during follow-up for 6--12 months. The pretreatment HBV DNA as level in PBMC HBV DNA positive was （7.2±1.1） lg copy/mL, which was much higher than that in negative group[（5.2±2. 1） lg copy/ mL] （t= 4. 3557, P〈0. 01）. Conclusions In patients who reach the standard of drug withdrawal, PBMC HBV DNA at the end of treatment is an important predictor for durability of antiviral the

关 键 词：参考标准 单核细胞 肝炎 乙型 慢性 肝炎病毒 乙型 DNA 病毒 干扰素 类 核苷类 

分 类 号：R51[医药卫生—内科学]