不同HBeAg状态慢加急性肝衰竭患者临终前HBV DNA载量的动态分析  

Dynamics of serum HBV DNA levels during the terminal phases of acute-on-chronic hepatitis B liver failure with different HBeAg status

作　　者：赖菁[1] 淦伟强[1] 谢冬英[1] 张卡[1] 柯伟民[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：《中华肝脏病杂志》2012年第7期522-525,共4页Chinese Journal of Hepatology

摘　　要：目的探讨不同HBeAg状态慢加急性肝衰竭（ACLF）患者临终前HBV DNA载量的动态变化及其临床意义。方法回顾陛分析107例ACLF患者临终前29～56d、15～28d和0～14d血清HBeAg、抗-HBe和HBV DNA载量，比较不同HBeAg状态和时间段患者的HBV DNA载量差异。两组间均数比较采用t检验，多组均数之间比较采用ONE-WAY ANOVA分析。结果HBeAg（＋）患者37例，上述3个时间段HBV DNA载量依次为（6．11±1．63）、（5．61±1．50）、（5．29±1．96）log10拷贝／ml；70例抗-HBe（＋）患者顺次为（4．63±1．82）、（5．81±1．78）、（4．93±1．73）log10拷贝／ml。HBeAg（＋）组与抗。HBe（＋）组相同时间段比较，HBV DNA载量在临终前29～56d差异有统计学意义（t=2．606，P=0．015，P〈0．05），但临终前15～28d和0～14d的差异均无统计学意义（P〉0．05）。同组内三个时段HBV DNA载量的两两比较，HBeAg（＋）组差异均无统计学意义（P〉0．05）；抗-HBe（＋）组在临终前29～56d与15～28d或0～14d的差异也无统计学意义（P〉0．05），但临终前15～28d和0～14d的差异有统计学意义（P=0．026，P〈0．05）。结论在致死性ACLF的启动，HBeAg（＋）患者HBV DNA水平高于抗-HBe（＋）者。随着肝衰竭恶化，HBeAg（＋）患者HBV DNA载量维持一定水平，而抗-HBe（＋）患者HBV DNA载量在终末期呈下降状态。Objective To investigate the dynamics and clinical significance of serum hepatitis B virus （HBV） DNA levels during the terminal phase of acute-on-chronic liver failure （ACLF） with different hepatitis B e antigen （HBeAg） status. Methods en patients with terminal ACLF were tested for HBeAg status by electrochemiluminescence irnmunoassay and serum HBV DNA levels by real-time PCR at three chronological time ranges, representing increasing severity of disease phases prior to death （day 0）： 29-56 d, 15-28 d, and 0-14 d. Results In the 37 HBeAg（＋） patients, HBV DNA levels at above-mentioned phases were 6.10± 1.63, 5.61 ± 1.50, and 5.29± 1.96 log10 copies/mL. In the 70 anti-HBe（＋） patients, HBV DNA levels were 4.63 ± 1.82, 5.81 ± 1.78, and 4.93 ± 1.73 log10 copies/mL. Phase to phase comparisons revealed that the HBV DNA level in the HBeAg（＋） group was significantly higher than that in the anti-HBe（＋） group at 29-56 d （P〈0.05）, and that 15-28 d and 0-14 d were not significantly different （P〉0.05）. Intragroup comparisons of phases revealed no significant differences in the HBeAg（＋） group （P〉 0.05）, but a significant difference between 15-28 d and 0-14 d （P〈0.05） for the anti-HBe（＋） group. Conclusion Serum levels of HBV DNA in patients with HBeAg positivity are higher than those in patients with anti-HBe positivity as the disease phase of ACLF nears fatality. Following the deterioration to liver failure, the HBV DNA load in HBeAg（＋） patients remains stable while that in anti-HBe（＋） patients decreases.

关 键 词：肝炎 乙型 慢性 肝炎E抗原 肝功能衰竭 

分 类 号：R512.62[医药卫生—内科学]