定量检测慢性乙型肝炎患者肝组织乙型肝炎病毒DNA的临床价值  

Quantitative detection of intrahepatic hepatitis B virus DNA in patients with chronic hepatitis B

作　　者：吕卉[1] 马立宪[1] 徐皖苏[1] 张惠芸[1] 于丽君[1] 段洪英[1] 

机构地区：[1]济南市传染病医院一科,250021

出　　处：《中华肝脏病杂志》2003年第3期173-175,共3页Chinese Journal of Hepatology

摘　　要：目的探讨慢性乙型肝炎(CHB)患者肝内乙型肝炎病毒(HBV)DNA载量与血清HBV DNA、乙型肝炎病毒e抗原(HBeAg)水平的相关性及其在抗病毒治疗中的意义.方法41例HBeAg阳性CHB患者,在干扰素α和拉米夫定联合治疗前进行肝穿刺,取肝组织分别进行HBV DNA检测及组织学检查,据肝组织HBVDNA载量小于等于或大于104fg/cm3将其分为两组,治疗前及治疗期间监测其肝功能、血清HBeAg及HBV DNA情况.结果(1)肝组织HBV DNA载量高于血清HBV DNA载量(对数值:4.081±1.127与3.163±1.010,t=2.218,P＜0.05),二者高度相关(r=0.840,t=4.322,P＜0.001);肝组织HBV DNA载量与血清HBeAg亦呈正相关(r=0.459,t=3.056,P＜0.005).(2)肝组织HBV DNA载量与肝组织炎症活动度呈反向关系(x2=3.874,P＜0.05).(3)治疗期间两组患者血清HBV DNA水平均明显下降,治疗前肝组织HBV DNA水平低者效果较好;治疗1年时HBeAg、抗-HBe血清转化率以肝组织HBV DNA水平低者为高(HBeAg转阴率68.4%与36.4%,x2=4.194,P＜0.05;抗-HBe阳转率73.7%与40.9%,x2=4.447,P＜0.05).结论肝组织HBV DNA水平较血清HBV DNA、HBeAg水平更能准确反映肝组织HBV DNA复制情况,且能间接反映机体的免疫状态,可作为抗病毒治疗适应证选择及疗效预测因子.Objective To study the relationships between intrahepatic HBV DNA level and serum HBV DNA level, between intrahepatic HBV DNA level and hepatitis B e antigen (HBeAg) level in patients with chronic hepatitis B (CHB), and assess the valuation of pretreatment liver HBV DNA level in antivirus therapy. Methods Liver specimens taken from 41 HBeAg-positive CHB patients before antivirus treatment were divided into two parts, one for histological examination, and the other for intrahepatic HBV DNA quantified detection by PCR-fluorescence. At the same time, serum levels of HBV DNA and HBeAg were detected. The patients were classified into two groups according to the pretreatment intrahepatic HBV DNA level(≤10~4 fg/cm3 in group A, >10~4fg/cm3 in group B) and accepted interferon α-lb(3MU every day for 26 weeks) in combination with lamivudine (100 mg per day for 52 weeks). During the treatment, the serum levels of alanine aminotransferase (ALT), HBV DNA and HBeAg seroconversion rate were monitored. Results (1) The level of liver HBV DNA was much higher than that of serum HBVDNA (4.081±1.127 vs 3.163±1.010,t= 2.218, P<0.05). Liver HBV DNA level had positive correlation to serum HBV DNA level (r = 0.840, t = 4.322, P < 0.001) and serum HBeAg level (r = 0.459, t = 3.056, P < 0.005). (2)Intrahepatic HBV DNA level was negative correlation to the severity of liver damage (x2 = 3.874, P<0.05). (3)Serum HBV DNA level in all the patients reduced remarkedly after therapy, especially in group A. At the end of 52 weeks, the rates of HBeAg and anti-HBe seroconversion in group A were higher than those in group B (68.4% vs 36.4%, x2 = 4.194, P < 0.05; 73.7% vs 40.9%, x2 = 4.447, P<0.05). Conclusions Intrahepatic HBV DNA is a more valuable marker than serum HBV DNA or HBeAg to assess HBV replication, and can reflect the status of body immunity indirectly. It may be a useful indicator for the efficacy of antivirus treatment.

关 键 词：定量检测 慢性乙型肝炎 肝组织 乙型肝炎病毒 DNA 拉米夫定 干扰素 

分 类 号：R512.62[医药卫生—内科学]