248例慢性乙型肝炎病毒感染者免疫清除期演变规律的研究  

Dynamic study of HBV immune clearance in 248 patients with chronic HBV infection in Shenzhen,China

作　　者：艾书玲[1] 何清[1] 唐奇远[1] 敖飞健[1] 廖雪姣[1] 吕德良 赵连三[3] 

机构地区：[1]广东医学院附属深圳市第三人民医院,广东深圳518112 [2]深圳市慢性病医院,广东深圳518020 [3]四川大学华西医院,四川成都610041

出　　处：《中国病毒病杂志》2013年第5期382-386,共5页Chinese Journal of Viral Diseases

基　　金：深圳市科技计划项目(201103132)

摘　　要：目的阐明慢性乙型肝炎病毒（HBV）感染自然病程中免疫清除期不同阶段血清学及肝脏病理的演变规律。方法将处于免疫清除期的慢性乙型肝炎（CHB）患者，按照其肝组织纤维化分期由轻到重（SO、s1、s2、s3-s4）将免疫清除期划分为初、早、中、后4个阶段，统计不同阶段患者年龄、丙氨酸氨基转移酶（A1．T）、HBVDNA定量、肝组织炎症分级及肝组织乙型肝炎核心抗原（HBcAg）分布的关系。结果符合免疫清除期纳入标准患者248例，男性187例，女性61例，平均年龄（31．7±7．5）岁。处于初、早、中、后4个阶段的患者分别为15例、141例、54例、38例，相应年龄分别为（27．40±4．87）岁、（30．74±6．12）岁、（32．85±9．40）岁、（35．45±8．38）岁，ALT分别为（64．73±38．81）U／L、（103．06±82．54）U／L、（165．83±263．73）U／L、（146．34±168．23）U／L，血清HBVDNA载量分别为（7．36±1．30）lgIU／ml、（7．26±0．92）lgIU／ml、（6．92±1．08）lgIU／ml、（6．47±1．10）lgIU／ml。不同阶段患者年龄、ALT、HBVDNA载量、肝组织炎症分级及HBcAg分布差异均有统计学意义（P值均〈0．05）。结论免疫清除期是肝组织炎症逐渐活跃，HBVDNA载量持续下降的演变过程。随着不同阶段的进展，肝组织HBcAg分布进展到以浆型为主。Objective To study the dynamics of hepatitis B virus （HBV） immune clearance in patients with chronic HBV infection. Methods Patients with chronic HBV infections in immune clearance stages were re cruited according to the version 2010 Guideline for the Prevention and Treatment of Chronic Hepatitis B of China. Liver specimens were collected for pathologic examination to define the degrees of liver fibrosis. HBV DNA loads were detected by real-time PCR and HBcAg was examined by immunochemistry. Results A total of 248 patients （187 males, 61 females） were recruited in the study. Pathologic analysis of liver specimens categorizes the liver fibrosis into 4 degrees （SO, S1, S2, and S3-S4） and the HBV immune clearance was further divided into 4 stages （initial, early, medium and late） accordingly. Of the four stages initial, early, medium and late, the numbers of cases are 15, 141, 54 and 38, at the average age of 27.40±4.87, 30.74± 6.12, 32.85±9.40 and 35.45±8.38 years, the ALT levels were 64. 73 ± 38. 81, 103.06±82.54, 165.83 ±263.73 and 146.34±168.23 U/L, the serum HBV DNA loads were 7.36±1.30, 7.26±0.92, 6.92±1.08 and 6.47± 1.10 lg IU/ml, respectively. Significant differences were observed among ages, ALT levels, HBV DNA loads, degrees of liver inflammation and distributions of HBcAg at different stages （P〈0.05）. Conclusions Dynamic changes can be seen for the gradually intensified liver inflammation and constantlydecreased HBV DNA loads during the HBV immune clearance phase of patients with chronic HBV infection and HBcAg distributions shifted gradually from nucleus type to cytoplasm type.

关 键 词：肝炎 乙型 慢性 免疫清除期 肝脏病理 乙型肝炎核心抗原 

分 类 号：R512.62[医药卫生—内科学]