不同慢性HBV感染状态的临床特点分析  

The clinical characteristics of patients with different stages of chronic hepatitis B virus infection

作　　者：李勇年[1] 吴炜强[1] 翟佩任[1] 燕青松[1] 谢晓莉[1] 魏丽军[1] 高建兴[1] 连建奇[2] 

机构地区：[1]解放军第三二三医院感染科,陕西西安710054 [2]第四军医大学唐都医院传染病科

出　　处：《中国病毒病杂志》2011年第6期426-429,共4页Chinese Journal of Viral Diseases

基　　金：国家"十一五"艾滋病和病毒性肝炎等重大传染病防治科技重大专项(2008ZX10002-006)

摘　　要：目的探讨不同慢性乙型肝炎病毒(HBV)感染状态的临床特点及其与病情进展相关的因素。方法将1 733例慢性HBV感染者分为非活动性HBsAg携带者、HBeAg阳性慢性乙型肝炎、HBeAg阴性慢性乙型肝炎和乙型肝炎肝硬化4组,对比不同组患者之间的年龄、性别、HBV感染时间、血清HBV DNA和谷氨酸氨基转移酶(ALT)水平以及合并脂肪肝的比例。结果非活动性HBsAg携带者、HBeAg阳性慢性乙型肝炎、HBeAg阴性慢性乙型肝炎和乙型肝炎肝硬化4组患者的平均年龄依次分别为(33.4±12.5)、(25.3±8.5)、(32.9±10.7)和(43.2±11.4)岁;男性患者所占比率依次为56.7%、67.7%、71.1%和73.9%。非活动性HBsAg携带者与HBeAg阴性慢性乙型肝炎比较,两组间年龄和性别差异无统计学意义,其余各组年龄和性别间差异均有统计学意义。乙型肝炎肝硬化组的可能HBV感染年限[(8.8±6.0)年]明显大于非活动性HBsAg携带者组[(5.8±4.3)年]和HBeAg阳性慢性乙型肝炎组[(5.8±4.5)年]。HBeAg阳性慢性乙型肝炎组HBV DNA水平[(7.92±7.74)lg拷贝/ml]与非活动性HBsAg携带者[(3.00±0.00)lg拷贝/ml]和HBeAg阴性慢性乙型肝炎组血清HBV DNA水平[(5.51±5.00)lg拷贝/ml]比较,差异有统计学意义。HBeAg阳性慢性乙型肝炎[(108.8±79.0)U/L]、HBeAg阴性慢性乙型肝炎[(87.4±66.7)U/L]和乙型肝炎肝硬化[(109.9±82.7)U/L]3组的血清ALT水平也明显高于非活动性HBsAg携带者组[(25.2±10.7)U/L]。4组患者的血清HBV DNA水平大于4lg拷贝/ml的比例、血清ALT水平大于2倍正常值上限的比例及合并脂肪肝的比例间也存在明显差异。87例行肝脏组织病理学检查患者的病理诊断与临床诊断基本相符。结论不同类型的慢性HBV感染状态临床表现各异,相互间差异较大。较高年龄、男性、HBV感染持续时间长、血清HBV DNA和ALT水平高均与慢性HBV感染的病情进展相关。Objective To analyze the clinical characteristics of chronic hepatitis B virus（HBV） infection among inactive HBV carriers,HBeAg positive and negative hepatitis patients,as well as the patients of cirrhosis.Methods A total of 1 733 cases of chronic HBV infection were classified as inactive HBsAg carriers,hepatitis patients with positive and negative HBeAg and the patients of cirrhosis.We analyzed the age,gender,duration of HBV infection,serum level of HBV DNA and alanine aminotransferanse（ALT）,as well as fatty liver proportion among the four groups of HBV infection.Results The average ages of patients were 33.4±12.5,25.3±8.5,32.9±10.7 and 43.2±11.4 years,respectively for HBsAg carriers,HBeAg positive and negative chronic hepatitis B（CHB） patients and the patients of cirrhosis.There were more male than female patients for HBsAg carriers（56.7%）,hepatitis patients with positive HBeAg（67.7%）,hepatitis patients with negative HBeAg（71.1%）,as well as the patients of cirrhosis（73.9%）,respectively（P〈0.05）.Patients were older in the group of cirrhosis than in the other groups.The durations of chronic HBV infection were longer in the patients of cirrhosis[（8.8±6.0）years]than in inactive HBsAg carriers[（5.8±4.3）years]and in HBeAg positive CHB patients[（5.8±4.5）years].The levels of serum HBV DNA were higher in HBeAg positive chronic hepatitis B patients[（7.92±7.74）lg copies/ml]than in inactive HBsAg carriers[（3.00±0.00）lg copies/ml]and HBeAg negative chronic hepatitis B patients[（5.51±5.00）lg copies/ml].The levels of serum ALT were significantly lower in inactive HBsAg carriers[（25.2±10.7）U/L]than in CHB patients with positive[（108.8±79.0）U/L]and negative HBeAg[（87.4±66.7）U/L],as well as in the patients of cirrhosis[（109.9±82.7）U/L].There were also significant differences in the percentages of high level of HBV DNA（greater than 4 lg copies/ml）,abnormal high level of serum ALT（greater than two times of upper limit of normal） and acco

关 键 词：肝炎 乙型 慢性 慢性乙型肝炎病毒 肝硬化 

分 类 号：R512.62[医药卫生—内科学]