儿童乙型肝炎血清乙型肝炎病毒共价闭合环状DNA与临床和病理分级分期的关系  

Relationship between serum hepatitis B virus covalently closed circle DNA and clinical stage as well as pathological grade of chronic hepatitis B in children

作　　者：雷晓燕[1] 孙永红[1] 杨菊兰[1] 袁宏[2] 姜惠玲 

机构地区：[1]甘肃省人民医院儿科,兰州730000 [2]兰州大学第一医院传染科,730030 [3]张掖市民乐县医院儿科,734500

出　　处：《中国小儿急救医学》2013年第3期292-294,共3页Chinese Pediatric Emergency Medicine

基　　金：甘肃省自然科学基金项目（099RJYA001）

摘　　要：目的了解慢性乙型肝炎患儿血清乙型肝炎病毒共价闭合环状DNA（hepatitis B virus covalently closed circleDNA，HBVcccDNA）与病情、肝功能指标及肝组织病理变化的关系。方法选择HBV—DNA阳性124例乙型肝炎患儿，其中携带者65例，慢性乙型肝炎59例（轻度31例、中度18例、重度10例），检测其血清HBVcccDNA及肝功能，对其中的46例患儿进行了肝脏穿刺，对肝组织进行炎症分级及纤维化分级。结果中、重度慢性乙型肝炎患儿血清HBVcccDNA阳性率（77．8％、100％）高于携带者和轻度组（32．3％、54．8％）（χ2=25．429，P〈0．01），患儿病情越重外周血HBVcccDNA检出率越高。血清HBVcccDNA阳性组的谷丙转氨酶、谷草转氨酶、总胆红素[（95．6±18．2）U／L、（88．8±20．3）U／L、（68．4±24．6）μmol／L]均高于阴性组[（52．5±17．7）U／L、（48．4±21．4）U／L、（28．3±23．9）μmol／L]（t=15．572、10．750、17．067，P均〈0．01）。血清cccDNA与肝组织炎症活动度和纤维化程度无明显相关性。结论血清HBVcccDNA是代表病毒复制的一个敏感指标，病情越重．外周血HBVcccDNA检出率越高，但其与肝组织炎症及纤维化并非完全一致，所以其不能完全反映肝脏的损伤程度。Objective To study the relationship between serum hepatitis B virus covalently closed circle DNA （HBV cccDNA） as well as liver function and liver tissue pathological changes in children with chronic hepatitis B. Methods One hundred and twenty-four HBV-DNA positive children with hepatitis B were enrolled. Among 124 patients,65 cases were HBV carriers,59 cases were chronic hepatitis （ mild in 31 cases,moderate in 18 cases and severe in 10 cases）. HBV cccDNA in serum and liver function were detected ,46 of which underwent liver biopsy and liver tissue inflammation and fibrosis grading classification was made. Results In moderate and severe cases, positive rates of serum HBV cccDNA （77.8 % , 100% ） were higher than those of the HBV carriers and mild cases （ 32. 3%, 54. 8% ） （ χ2 = 25. 429, P 〈 0. 01 ）, indicating more severe illness in children,detection rate of serum HBV cecDNA was higher. ALT ,AST, and TBIL were higher in serum HBV cccDNA positive group than those of negative group[ （95. 6 ± 18. 2） U/L vs （52. 5 ± 17.7） U/L, （88.8 ±20.3） U/L vs （48.4 ±21.4） U/L, （68.4 ±24.6） μmol/L vs （28.3 ±23.9） μmol/L] （ t = 15. 572, 10. 750, 17. 067, P 〈 0. 01 ）. Serum HBV cccDNA and liver inflammatory activity and fibrosis showed no significant correlationship. Conclusion Serum HBV cccDNA is a sensitive indicator of viral replication, the more severe the disease situation, the peripheral HBV cccDNA detection rate is higher. But it is not entirely consistent with liver inflammation and fibrosis, so it can not completely reflect the degree of liver damage.

关 键 词：慢性乙型肝炎 共价闭合环状DNA 儿童 

分 类 号：R725.7[医药卫生—儿科]