慢性乙型肝炎患者病毒e系统状态与肝纤维化关系的研究

目的:观察慢性乙型肝炎患者乙型肝炎病毒e系统状态和复制指标在肝纤维化发生过程中的变化及其与血清纤维化标志的关系,探讨它们在肝纤维化发生过程中的作用及其可能的临床意义.方法:188例慢性乙型肝炎患者根据肝纤维化程度分为S0～S4期等5组,分别用定量PCR及放免法检测患者血清中HBV-DNA及肝纤维化标志透明质酸、Ⅳ型胶原、Ⅲ型前胶原和层粘连蛋白的含量;HBeAg和抗-HBe采用酶联免疫吸附法(ELISA)检测,并观察其在不同肝病理纤维化分期时的变化.结果:随着肝纤维化程度加重,血清HBV-DNA含量逐渐升高,从S1期开始显著增加(P＜0.01);而HBeAg阳性率逐渐降低,S3、S4期较S0显著减少(P＜0.05和P＜0.01);抗-HBe阳性率呈相反的变化趋势,在S3和S4期的阳性率明显高于S0期(P＜0.05和P＜0.01).血清HBV-DNA( )HBeAg( )组血清纤维化标志最低,HBV-DNA(-)抗-HBe( )组最高,两者差异有显著性(P＜0.01).结论:HBV复制和e系统状态的改变与肝纤维化程度密切相关,肝内病毒复制标志与血清纤维化标志联合检测,对于判断肝纤维化程度和指导抗病毒治疗有重要的价值.

Relationship between the status of hepatitis B virus e system and liver fibrosis in patients with chronic hepatitis B

Objective:To investigate the changes in hepatitis virus B(HBV)replication marker contents and the status of e system during the course of hepatic fibrosis and its relationship with serum fibrosis markers.Methods:Serum HBV-DNA and levels of hepatic fibrosis marker(HA,PCO,CO,LN)were determined with quantitative PCR and radioimmunoassay respectively.The positive rates of HBeAg and anti-HBe were assayed by ELISA method in 188 patients with chronic hepatitis B,which were divided into 5 groups according to hepatic fibrosis severity.Results:Along with the progression of hepatic fibrosis(from stage S0to S4),the levels of serum HBV-DNA were increased progressively and began to significantly augment from stage S1(P<0.01),while the positive rates of HBeAg were decreased progressively and significant reduced from stage S3.The positive rates of anti-HBe were progressively increased with increasing severity of hepatic fibrosis.In S4stage,the severity of hepatic fibrosis reached the peak.The contents of serum fibrosis markers were lowest in patients with HBV-DNA(+)HBeAg(+),while reached the highest level in patients with HBV-DNA(-)anti-HBe(+).Conclusion:HBV replication and e system status might be associated with hepatic fibrosis.Combination detection of virus replication,e system status and serum fibrosis marker contents might be valuable in the judgment of the severity of hepatic fibrosis,and also in the assessment of the treatment in patients with HBV.