乙型肝炎相关性肝癌患者血清低拷贝HBV DNA检测的临床分析  

Clinical analysis of low serum hepatitis B virus DNA level in patients with HBV-related hepatocellular carcinoma

作　　者：童永喜[1] 项波[2] 潘克女[3] 黄海军[1] 潘红英[1] 

机构地区：[1]浙江省人民医院感染科,浙江杭州310014 [2]杭州市第六人民医院感染科,浙江杭州310023 [3]杭州市第六人民医院检验科

出　　处：《中华全科医学》2016年第4期549-551,共3页Chinese Journal of General Practice

基　　金：浙江省杭州市科技局重点专科专病项目(2010-0733Q15)

摘　　要：目的通过对乙型肝炎相关性肝癌(HCC)患者血清低拷贝HBV DNA的检测,探讨乙肝病毒低复制水平与肝癌发生、发展的相关性,明确乙型肝炎患者血清低拷贝HBV DNA检测的临床意义。方法在所有乙型肝炎相关性HCC患者中,选取85例血清HBV DNA水平持续小于1 000 IU/ml的患者,对其病情发生、发展、演变进行系统的回顾分析,同时获得其血清,进行乙型肝炎标志物、肝功能、甲胎蛋白及低拷贝HBV DNA的检测,最后分析各项指标与低拷贝HBV DNA的相关性,分析其临床意义。结果 85例乙型肝炎相关性HCC患者当中,乙型肝炎标志物HBe Ag阳性者有15例,占17.65%,HBe Ag阴性者70例,占82.35%。肝功能指标(ALT及AST)异常者52例,占61.18%。甲胎蛋白(AFP)异常升高者65例,占76.47%。低拷贝HBV DNA水平大于20 IU/ml者72例,占84.71%。低拷贝HBV DNA水平小于20 IU/ml者13例,占15.29%。结论乙型肝炎相关性HCC与乙型肝炎病毒持续复制有关,常规的HBV DNA检测只能检测HBV DNA水平大于1 000 IU/ml的患者,乙肝病毒低复制患者往往会被忽视,导致患者不能及时抗病毒治疗而使得病情发展。因此这种检测已不能满足临床的实际要求,乙型肝炎患者低拷贝HBV DNA检测更有临床指导意义。Objective To detect the levels of serum hepatitis B virus（ HBV） DNA of the patients with HBV-related hepatocellular carcinoma（ HCC）,explore the correlation between the low level replication of hepatitis B virus DNA and the pathogenesis of hepatocellular carcinoma,and investigate the clinical significance of detecting serum HBV DNA level in patients with chronic hepatitis B at a lower level of replication. Methods We selected 85 patients with continuous lower level of serum HBV DNA（ 1 000 IU / ml） among the patients with HBV-related HCC. The occurrence,development and evolution of their diseases were systematically reviewed. The serum samples of them were prepared for the tests of HBV markers,liver function,AFP and HBV DNA levels. The relations between the DNA level and other indexes were analyzed.Results Among the 85 HCC patients,15 cases（17. 65%） were with HBe Ag-positive,70 cases（ 82. 35%） were with HBe Ag-negative. 52 cases（61. 18%） were with abnormal（ ALT and AST）,65 cases（76. 47%） were with an abnormal increase of AFP. 72 cases（84. 71%） were with low HBV DNA levels was more than 20 IU / ml,while 13 cases（15. 29%）low HBV DNA levels less than 20 IU / ml. Conclusion HBV-related HCC is associated with the duration of hepatitis B virus replication. The conventional methods can only detect the HBV DNA levels more than 1 000 IU / ml. The patients with a low HBV DNA level are easy to be ignored,and receive timely the antiviral therapy that lead to disease development. The more precise detection methods for low HBV DNA level will have much clinical significance.

关 键 词：肝炎病毒 乙型 肝细胞癌 甲胎蛋白 低拷贝 乙型肝炎病毒-DNA 

分 类 号：R512.62[医药卫生—内科学]