HBeAg阳性和HBeAg阴性慢性乙型肝炎患者血清学指标及肝组织病理学比较  

Comparison of serum indexes and liver pathology of 537 patients with HBeAg positive-and HBeAg negative-chronic hepatitis B

作　　者：唐奇远[1] 何清[1] 艾书玲[1] 唐蔚[1] 敖飞健[1] 李知玉[1] 张斌[1] 白冰[1] 

机构地区：[1]深圳市第三人民医院肝病科,深圳市518112

出　　处：《中华实验和临床感染病杂志（电子版）》2013年第1期28-31,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的回顾性分析HBeAg阳性和HBeAg阴性慢性乙型肝炎（CHB）患者血清学指标及肝组织病理指标的异同。方法对537例CHB患者的临床资料进行统计，分析HBeAg阳性（321例）和HBeAg阴性（216例）CHB患者ALT、HBVDNA定量、肝组织炎症水平、肝组织纤维化程度以及肝细胞HBcAg分布等指标的差异。结果两组患者ALT（Z=1．391，P=0．164）及肝组织炎症水平（X2=7．1189，P=0．0682）差异无统计学意义；HBeAg阳性组患者HBVDNA载量高于HBeAg阴性组（Z=12．893，P〈0．001），而肝组织纤维化程度低于HBeAg阴性组（X2=42．871，P〈0．0001）；两组患者肝细胞HBcAg分布不同，HBeAg阳性组患者的HBcAg主要分布为核型和混合型，HBeAg阴性组患者HBcAg则主要表现为阴性，差异具有统计学意义（X^2=119．3522，P〈0．0001）。结论HBeAg阴性与HBeAg阳性CHB患者的肝组织炎症水平相似，然而因HBeAg阴性组HBVDNA载量低、肝纤维化程度重，故存在更加广泛而急迫的抗病毒治疗指征。Objective To investigate the serum indexes and liver pathology of HBeAg positive and negative patients with chronic hepatitis B （CHB）. Methods Total of 537 patients with CHB were enrolled. The levels of ALT, HBV DNA loads, hepatic histological inflammation grades, fibrosis stages and HBcAg subcellular distribution of the two groups were compared, respectively. Results There were 321 cases with HBeAg positive and 216 cases with HBeAg negative. There was no significant difference of the levels of ALT （Z= 1. 391,P =0. 164） and hepatic histological inflammation grades （X2 = 7. 1189, P = 0. 0682） between the two groups. Compared with the HBeAg negative group, patients in HBeAg positive group had significantly higher serum HBV DNA levels （Z = 12. 893, P 〈 0. 001 ）. But the fibrosis stages of HBeAg negative was significantly advanced than that of HBeAg positive group （X2 = 42. 871, P 〈 0. 0001 ）. The predominant forms of HBcAg subcellular distribution were nuclei type and mixed type in patients with HBeAg positive. However, HBcAg was negative in most HBeAg negative patients （X2 = 119. 3522, P 〈 0. 0001 ）. Conclusions The hepatic histological inflammation was similar between HBeAg positive and negative patients. With lower HBV DNA levels and severer fibrosis, HBeAg negative CHB patients should accept antiviral therapy more urgently and reasonably.

关 键 词：肝炎 乙型 慢性 肝组织病理学 肝炎病毒DNA 乙型 肝炎病毒e抗原 乙型 丙氨酸氨基转移酶 

分 类 号：R512.62[医药卫生—内科学]