用HBV DNA定量和HBeAg定量监控抗病毒治疗  

Monitoring of antiviral therapy of hepatitis B with quantitative determination of HBV DNA and HBeAg

作　　者：张华[1] 李永兴[1] 许叔祥[1] 

机构地区：[1]上海瑞金医院卢湾分院南洋放免中心,上海200020

出　　处：《上海医学检验杂志》2003年第4期203-205,共3页Shanghai Journal of Medical Laboratory Sciences

摘　　要：目的　定量检测乙型肝炎病毒脱氧核糖核酸 (HBVDNA)和乙型肝炎病毒e抗原 (HBeAg)来监控抗病毒药物治疗的反应和乙肝患者病情的发展。方法　 4 5例HBVDNA阳性、HBeAg阳性的患者分成 2组 ,一组用拉米呋啶治疗 ,另一组用苦参素治疗。用微粒酶免疫荧光分析测定其HBeAg浓度 ,用PCR 酶联法定量测定其HBVDNA拷贝数。结果　服用拉米呋啶 12周的患者血清HBVDNA拷贝数和HBeAg浓度均显著下降 ,与服药前差异有显著性 (P <0 .0 1) ,而服用苦参素治疗的患者 ,其血清HBeAg浓度在治疗 4周后也有一定下降 ,与服药前差异有显著性 (P <0 .0 1) ,但是HBVDNA拷贝数却无明显变化 (P >0 .0 5 )。拉米呋啶对HBVDNA和HBeAg抑制率分别为 83.3%和 6 0 % ,HBVDNA <4× 10 3 的占 5 0 % ,而HBeAg转阴的占 13.3%。苦参素对HBVDNA和HBeAg抑制率分别为 6 .7%和 5 3.3% ,HBVDNA <4× 10 3 的占 6 .7% ,而HBeAg转阴的占 6 .7%。在拉米呋啶治疗不同疗效的各组中 ,服药前的HBeAg水平和HBVDNA拷贝数差异无显著性 (P >0 .0 5 )。治疗后HBeAg的增加或减少基本与HBVDNA平行 ,但是有 7例HBVDNA量有变化者 ,而HBeAg量却无变化。 结论　拉米呋啶的治疗效果明显优于苦参素 ,用HBVDNA和HBeAg定量联合检测可更全面有效地评估抗病毒药物治疗效果。Objective To monitor the response to the antiviral therapy of chronic hepatitis B with quantitative measurement of hepatitis B virus DNA (HBV DNA) and HBeAg. Methods Forty-five patients positive for HBeAg and HBV DNA were divided into two groups, one group received lamivudine orally, and the other received Marine injection. The concentration of HBeAg was evaluated with a microparticle capture enzyme immunoassay, and HBV DNA was analyzed with quantitative PCR. Results In patients receiving lamivudine HBV DNA and HBeAg had a significant decrease ( P <0.01), but in patients receiving Marine HBeAg had a significant decrease ( P <0.01), but HBV DNA had no significant change ( P >0.05). The suppression of lamivudine to HBV DNA and HBeAg is 83.3% and 60% respectively compared with 6.7% and 53.3% of Marine. The loss of HBeAg and HBV DNA<4×10 3 occurred in 6.7% and 50% respectively of lamivudine, compared with 6.7% and 6.7% of Marine. A statistically significant correlation was not observed between the concentration of HBeAg and HBV DNA before therapy in different groups of different therapeutic effect ( P >0.05). Decrease or increase of HBeAg concentration paralleled with HBV DNA. 7 patients HBV DNA turned negative but HBeAg remained positive. Conclusions The therapeutic effect of lamivudine is much better than that of Marine. The quantitative measurement of HBV DNA and HBeAg at the same time may be more useful for monitoring and predicting the response to antiviral therapy.

关 键 词：乙型肝炎 乙型肝炎病毒脱氧核糖核酸 乙型肝炎病毒E抗原 抗病毒治疗 疗效评估 

分 类 号：R512.62[医药卫生—内科学]