慢性HBV感染者复发期和免疫清除期在不同年龄阶段的临床病毒学特征  

Clinical and virological characteristics of patients with chronic hepatitis B during immune clearance or reactivation

作　　者：吴殿磊[1,2] 徐光华[1] 冯继红[1] 陈延平[1] 刘娜[1] 

机构地区：[1]延安大学附属医院感染病科 [2]延安大学医学院,陕西省延安市716000

出　　处：《世界华人消化杂志》2011年第15期1639-1643,共5页World Chinese Journal of Digestology

摘　　要：目的:研讨慢性乙型肝炎在不同年龄阶段免疫耐受期和复发期临床病毒学特征.方法:随机选取免疫清除期和复发期慢性乙型肝炎患者570(免疫清除期患者300例和复发期患者270例).按年龄分为:<20岁组,20-40岁组,>40岁组.用实时荧光定量聚合酶链反应(FQ-PCR)及时间分辩荧光免疫分析(TRFIA)技术检测其血清中HBVDNA、HBeAg含量,用速率法检测ALT水平.同时对患者肝脏进行B型超声探查.结果:复发期患者主要在>40岁组(166/270),其比例显著高于其他组,而且,男性比女性比例明显高(P=0.000,0.002).在270例复发期患者中,ALT水平低于2倍正常值水平的患者占有相当的比例(12.59%,45.93%).免疫清除期患者主要分布于20-40岁组(153/300),对300例免疫清除期患者随访10-50mo,结果显示193例患者实现了有效的血清转换(HbeAg-antiHBe),血清转换主要发生在20-40岁组(P=0.003,0.002),而且越年轻转换时间越短(P=0.001,0.004).结论:在不同的年龄阶段,免疫耐受期和复发期存在完全不同的临床病毒学特征.AIM：To investigate the clinical and virological characteristics of patients with chronic hepatitis B（CHB）during the immune clearance or reactivation phases.METHODS：Five hundred and seventy CHB patients during the immune clearance or reactivation phases who had a disease history of more than 12 mo were selected from Yan＇an region in China.These patients were divided into three age groups（〈20,20-40,〉40）.Serum levels of HBV DNA and HBeAg were measured by realtime fluorescence quantitative polymerase chain reaction（FQ-PCR）and time-resolved fluoroimmunoassay（TRFIA）,respectively.Serum level of anine aminotransferase（ALT）was also measured.RESULTS：Patients（166/270）during the reactivation phase were mostly aged above 40 years（166/270）and more likely to be males（P=0.000,0.002）.Cases with an ALT level two times less than the normal value accounted for considerable proportions in patients during the reactivation phase（12.59%,45.93%）.Patients during the immune clearance were distributed mainly in the 20-40 age group（153/300）.Of 300 patients during the immune clearance phase who were followed up for more than 50 mo,193 achieved spontaneous HBeAg seroconversion.Younger patients achieved HBeAg seroconversion in a shorter time than older ones（P=0.001,0.004）.CONCLUSION：There are significantly different clinical and virological characteristics among patients during immune clearance or reactivation in different age groups.

关 键 词：慢性乙型肝炎 免疫清除 复发 临床病毒学特征 

分 类 号：R512.62[医药卫生—内科学]