不同HBVDNA水平乙型病毒性肝炎肝硬化患者的临床特征及HBeAg状态比较

目的研究乙型病毒性肝炎（乙肝）肝硬化活动期患者HBVDNA水平与HBeAg状态的分布和临床特点及意义。方法调查337例乙肝肝硬化住院患者，采用荧光定量PCR方法检测HBVDNA载量，MEIA法检测HBV血清标志物，常规方法检测肝功能，同时行超声检查。比较不同HBVDNA水平患者中HBeAg阳性和阴性、不同Child—Push分级和肝癌患者的比例，以及不同年龄患者中不同HBVDNA水平和HBeAg状态患者的比例。结果80．4％（271／337）患者HBVDNA阳性，31．5％（106／337）患者HBeAg阳性，68．5％（231／337）患者HBeAg阴性。HBVDNA水平越高者中HBeAg阳性者比例越高，HBeAg阴性者比例越低；不同HBVDNA水平患者中不同Child-Pugh分级患者比例差异无统计学意义，但HBVDNA3～41g拷贝／ml患者中肝癌的比例高于HBVDNA〈31g拷贝／ml患者（P=0．014）和≥71g拷贝／ml患者（P=0．009）；HBeAg阴性患者比例随年龄增大而增加，但HBeAg阳性患者与阴性患者的临床特征差异无统计学意义。结论绝大多数乙肝肝硬化患者HBVDNA阳性，且2／3患者HBeAg阴性。长期抗病毒治疗可能有助于改善乙肝肝硬化患者的病情和预后。

The comparison of clinical characteristics and HBeAg status in HBV liver cirrhosis patients with different HBV DNA levels

Objective To study the chnical characteristics and HBeAg status in HBV liver cirrhosis patients with different HBV DNA levels. Method Three hundred and thirty-seven patients with liver cirrhosis caused by chronic HBV infection were investigated. HBV DNA levels were detected by PCR, and HBV markers were detected by MEIA. The ratio of patients with HBeAg positive or negative in groups with different HBV DNA levels was compared, and the clinical characteristics in patients with different HBV DNA levels and HBeAg status were evaluated. Results The positive ratio of HBV DNA and HBeAg were 80.4% （271/337） and 31.5% （106/337）. The negative ratio of HBeAg was 68.5% （231/337）. The proportion of patients with Child-Pugh grade A, B or C and hepatoceUular carcinoma （HCC） in different groups of HBV DNA levels and in different HBeAg status showed no significant difference, but the ratio of HCC in patients with HBV DNA 3-4 lg copies/ml was higher than that in patients with HBV DNA 〈 3 lg copies/ml （P = 0.014） and ≥7 lg copies/ml （P =0.009）. No significant difference of HBV DNA levels was found in different age groups, but the negative ratio of HBeAg increased with the increasing of the age. Conclusions More than 80% of patients with liver cirrhosis caused by chronic HBV infection are HBV DNA positive, and 2/3 of them are HBeAg negative. Suppressing HBV replication may improve the prognosis of HBV related cirrhosis and HCC.