昆明地区低病毒载量慢性乙肝患者血清高敏HBV DNA检测分析

  目的  探讨昆明地区持续低水平病毒血症的慢乙肝患者，高敏HBV-DNA载量、HBV的基因型分布特点、HBV P区耐药位点的突变特征，和HBeAg、HBsAg、ALT之间的关系及临床应用价值。  方法   采集2021年1月至2021年12月期间于昆明市第三人民医院就医的707例慢性乙肝患者的血清，分析高敏HBV-DNA、HBV的基因型以及HBV P区的耐药位点突变情况，并分析不同HBV-DNA载量与HBeAg、 HBsAg、ALT之间的关系。  结果  研究707例持续低载量慢性乙肝患者中，高敏HBV DNA（< 500 IU/mL）446例，占（63.50%），高敏HBV DNA 小于2000 IU/mL的慢乙肝患者共有576例，占（81.90%）；HBeAg 阳性262例（37.05%）；基因分型以C基因型占比最高60.53%（428/707）。在196例HBeAg阳性且HBV DNA < 2000 IU/mL患者组中，男性为主，占69.89%；ALT > 40 U/L占28.57%，有73.47%患者的HBV DNA > 20 IU/mL。在265例HBV DNA < 20 IU/mL的患者中，80.38%（213例）患者HBeAg阴性，19.62%（52例）HBeAg呈阳性。临床指标比较，HBeAg阳性率、ALT异常率、耐药位点和其它位点突变率在HBV DNA 载量水平不相同组之间差异有统计学意义（P < 0.05）。  结论  对持续低水平病毒血症的慢性乙型肝炎患者，选择高敏的PCR技术定期监测乙肝病毒HBV DNA，结合HBeAg、HBsAg 、ALT等临床指标的定量监测，可为后续患者的临床治疗提供客观的参考依据。

Analysis of Serum High-sensitivity HBV DNA in Patients with Chronic Hepatitis B with Low Viral Load in Kunming Area

  Objective  To investigate the relationship among high-sensitive HBV-DNA load , high-sensitivity HBV-DNA load, HBV genotype distribution, HBV P region drug resistance mutation, HBeAg, HBsAg, ALT and its value of clinical application in patients among the chronic hepatitis B with persistent low-level viremia in Kunming.   Methods  A total of 707 patients with chronic hepatitis B who received inpatient and outpatient treatment in the Third People’s Hospital of Kunming from January 2021 to December 2021 were selected. The relationship between different HBV-DNA loads and HBeAg, HBsAg and ALT was analyzed.   Results  Among the 707 chronic hepatitis B patients with persistent low load in the study, 446 cases had high-sensitivity HBV DNA load < 500 IU/ml, accounting for （63.50%）, and there were 576 chronic hepatitis B patients with high-sensitivity HBV DNA < 2000 IU/ml, accounting for （81.90%）; 262 cases （37.05%） were HBeAg positive; genotype C accounted for the highest proportion of 60.53% （428/707）. Among the 196 chronic hepatitis B patients with HBeAg （+） and HBV DNA < 2000 IU/mL, males were dominant, accounting for 69.89%; ALT > 40 U/L accounted for 28.57% and 73.47% of patients had HBV DNA > 20 IU/mL mL. Among the 265 chronic hepatitis B patients with HBV DNA < 20 IU/mL, HBeAg （-） accounted for 80.38% （213 cases）, and HBeAg （+） accounted for 19.62% （52 cases）. Compared with the clinical indicators, the positive rate of HBeAg, the abnormal rate of ALT, the mutation rate of drug resistance sites and other sites were significantly different among different HBV DNA load levels （P < 0.05）.   Conclusion  For chronic hepatitis B patients with persistent low-level viremia, the use of high sensitivity PCR technology to regularly monitor HBV DNA of hepatitis B virus in combination with quantitative monitoring of clinical indicators such as HBeAg, HBsAg, ALT, etc. can provide the objective reference for the clinical treatment of follow-up patients.