乙型肝炎表面抗原阳性特重度烧伤患者肝功能损害及乙型肝炎病毒再激活情况分析  

Analysis of liver damage and reactivation of hepatitis B virus in hepatitis B surface antigen positive patients after extremely severe burn injury

作　　者：卞徽宁[1] 赖文[1] 郑少逸[1] 刘族安[1] 黄志锋[1] 孙传伟[1] 马亮华[1] 李汉华[1] 陈华德[1] 

机构地区：[1]广东省人民医院广东省医学科学院烧伤与创面修复外科,广州510080

出　　处：《中华烧伤杂志》2015年第4期244-247,共4页Chinese Journal of Burns

摘　　要：目的分析HBsAg阳性特重度烧伤患者治疗过程中肝功能损害及乙型肝炎病毒（HBV）再激活情况，为HBV感染特重度烧伤患者肝功能损害的防治提供参考。方法对2004年1月－2014年12月笔者单位收治的54例HBsAg阳性特重度烧伤患者的病历资料进行回顾性分析。根据患者性别、入院时乙型肝炎e抗原（HBeAg）情况、入院时HBVDNA情况、治疗过程中是否并发脓毒症进行分类，统计患者治疗过程中是否发生肝功能损害或者HBV再激活。对数据行X。检验。结果（1）患者治疗过程中肝功能损害发生率高达85．2％（46／54）。男性患者发生肝功能损害的比例为35／38，显著高于女性患者的11／16，X。：4．867，P〈0．05。26例入院时HBeAg阳性患者、34例人院时HBVDNA阳性患者、36例治疗过程中并发脓毒症患者均发生肝功能损害，比例显著高于入院时HBeAg阴性患者、入院时HBVDNA阴性患者、治疗过程中未并发脓毒症患者的20／28、12／20、10／18，Y。值分别为11．801、18．384、20．574，P值均小于0．01。（2）患者治疗过程中HBV再激活发生率为29．6％（16／54）。男性患者发生HBV再激活的比例为13／38，女性患者发生HBV再激活的比例为3／16，两者比较差异无统计学意义（Y。=0．656，P〉0．05）。入院时HBeAg阳性患者、入院时HBVDNA阳性患者、治疗过程中并发脓毒症患者发生HBV再激活的比例分别为13／26、16／34、15／36，显著高于入院时HBeAg阴性患者、入院时HBVDNA阴性患者、治疗过程中未并发脓毒症患者的3／28、0／20、1／18，Х^2值分别为9．979、18．615、5．873，P〈0．05或P〈0．01。结论入院时HBsAg、HBeAg、HBVDNA阳性及治疗过程中并发脓毒症的特重度烧伤患者极易发生肝功能损害，HBV再激活风险较高，治疗中应动态监测HBVDNA和肝功能变化，及时了解病毒再激活情况。Objective To analyze the development of liver damage and reactivation of hepatitis B virus （HBV） during the treatment of extremely severe burn injury in HBsAg positive patients, in order to provide reference for prevention and treatment of liver damage in patients with HBV infection after extremely severe burn. Methods Medical records of 54 HBsAg positive patients after extremely severe burn injury admitted from January 2004 to December 2014 were retrospectively analyzed. Development of liver damage and HBV reactivation of these patients during the treatment were analyzed according to the classification of their gender, results of hepatitis B e antigen （HBeAg） and HBV DNA examinations on admission, and development of sepsis in the process of treatment. Data were processed with chi-square test. Results （ 1 ） The incidence of liver damage in the process of treatment of these patients was 85.2% （46/54）. Among all the patients, the proportion of liver damage was 35/38 in male, which was significantly higher than that in female （ 11/16, X 2 = 4. 867, P 〈 0.05）. Liver damage was found in all of 26 patients who were HBeAg positive on admission, 34 patients who were HBV DNA positive on admission, and 36 patients who developed sepsis in the process of treatment; the proportions were significantly higher than those in patients who were HBeAg negative on admission （20/28） , patients who were HBV DNA negative on admission （12/20） , and patients who did not develop sepsis in the process of treatment （ 10/18 ） , with X 2 values respectively 11. 801, 18. 384, and 20. 574, P values below 0.01. （2） The incidence of HBV reactivation in these patients was 29.6% （16/54）. Among all the patients, the proportion of HBV reactivation was 13/38 in male and 3/16 in female, with no statistically significant difference between them （ Х^2 = 0. 656, P 〉 0.05）. The proportions of HBV reactivation in patients who were HBeAg positive on admission, patients who were HBV DNA positive on admission, an

关 键 词：烧伤 免疫耐受 肝炎病毒 乙型 肝功能损害 病毒再激活 

分 类 号：R512.62[医药卫生—内科学] R644[医药卫生—临床医学]