乙肝加急性肝衰竭患者HBeAg与HBVDNA载量和终末期肝病模型分值关系的分析  

The relationship of HBeAg status with HBV DNA loads, MELD scores in patients with acute-on- chronic hepatitis B liver failure during terminal phases

作　　者：赖菁[1] 李学俊[1] 张绍全[1] 徐启桓[1] 朱建芸[1] 柯伟民[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：《中华实验和临床病毒学杂志》2012年第1期51-53,共3页Chinese Journal of Experimental and Clinical Virology

摘　　要：目的探讨乙型肝炎慢加急性肝衰竭（ACLF）患者临终前HBeAg状态与HBVDNA载量和MELD（终末期肝病模型）分值变化的关系及其临床意义。方法分析120例乙型肝炎ACLF患者临终前0～14d，15～28d和29～90d时段血清HBeAg状态、HBVDNA载量和MELD值。结果51例HBeAg阳性患者上述三时段的HBVDNA载量依次是（5．25±1．99），（5．45±1．47）和（6．06±1．77）log10拷贝／ml，MELD值分别为（30．33±5．25），（26．36±6．43）和（20．13±6．47）。而69例HBeAg阴性患者上述三时段的HBVDNA载量顺次是（5．14±1．84），（5．49±1．75）和（4．62±1．65）logl0拷贝／ml，MELD值按序为（32．38±9．95），（28．17±6．82）和（26．19．4-5．56）。同一时间段比较，HBeAg阳性与HBeAg阴性患者间HBVDNA载量和MELD值均仅在临终前29～90d的差异有统计学意义（P〈0．05）。三个时段间比较，不论HBeAg阳／阴性，HBVDNA载量的差异均无统计学意义（P〉0．05），而MELD值随着病情进展呈持续升高且差异均有统计学意义（P〈0．05）。结论为启动乙型肝炎ACLF，HBeAg阳性患者的HBVDNA水平高于HBeAg阴性者。一旦ACLF启动，无论HBeAg状态如何，持续高HBVDNA载量可促进病情向终末期发展。Objective To investigate the relationship and clinical significances of HBeAg status with serum HBV DNA loads,model for end-stage liver disease （MELD） scores in patients with acute-on-chronic hepatitis B liver failure during terminal phase. Methods 120 fatal patients were enrolled. At three phases of 0 -14 d, 15 -28 d and 29 -90 d before death, they were detected serum HBeAg, HBV DNA loads order meanwhile MELD scores were calculated. Results In 51 patients with HBeAg positive,HBV DNA levels were （ 5.25 ± 1.99）, （5.45 ± 1.47 ） and （6. 06 ± 1.77 ） log10 copies/ml while MELD scores were （ 30. 33 ± 5.25 ）, （26. 36 ± 6.43 ）and （20. 13 ±6.47） respectively. In 69 patients with HBeAg negative,HBV DNA loads were （5.14± 1.84） , （5.49± 1.75 ） and （4.62 ±1.65） log10 copies/ml while MELD scores were 32.38 ± 9.95, 28.17 26. 82 and 26. 19 ± 5.56 in sequence. Compared with the same phase between HBeAg-positive group and HBeAg-negative group,significant differences in both HBV DNA loads and MELD scores were found only at the phase of 29 - 90 d （P 〈 0. 05）. In multiple comparisons among three phases,regardless of the HBeAg status,there wasn＇t significant difference for HBV DNA loads （P 〉0. 05）. But increasing MELD scores are associated with the disease exacerbation and significant differences were found （P 〈 0.05）. Conclusions To initiate acute-on-chronic hepatitis B liver failure,serum HBV DNA loads of HBeAg-positive patients are higher than that of HBeAg-negative ones. Once ACLF has been initiated,sustained high HBV DNA loads may promote the disease worsened and be fatal regardless of the HBeAg status.

关 键 词：肝炎e抗原 乙型 肝功能衰竭 病毒载量 终末期肝病模型 

分 类 号：R512.62[医药卫生—内科学]