乙型肝炎患者治疗后血清中e抗原与病毒DNA水平的关系

目的 通过对乙型肝炎病毒血清学标志物(HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBcIgG)的检测及内标、外标两种聚合酶链反应(PCR)方法 检测乙型肝炎病毒载量的比对,更好地了解人体内乙型肝炎病毒携带情况,指导临床诊治.方法对经治疗后丙氨酸氨基转移酶(ALT)/天冬氨酸氨基转移酶(AST)正常、COBAS AMPLICOR定量PCR(内标法)检测不到乙肝病毒DNA(HBV-DNA)、用Abbott AxSYM微粒子酶免分析法(MEIA)检测乙型肝炎病毒表面抗原(HBsAg)阳性、表面抗体(抗-HBs)阴性、e抗原(HBeAg)阳性(HBeAg＞4 S/CO)、抗-HBe阴性、抗-HBcIgG阳性的42例血清,再用上海复星长征医学科学有限公司提供的HBV-PCR外标法荧光定量检测试剂盒,Light Cycler实时荧光定量PCR仪检测.结果 42例ALT/AST正常,HBeAg阳性(HBeAg＞4 S/CO以上),HBeAg的平均值42.26 S/CO.COBAS AMPLICOR定量PCR(内标法)未检测到HBV-DNA(＜300拷贝/ml)的血清;用Light Cycler定量PCR仪(外标法)检测HBV-DNA,有7例为阳性,7例HBV-DNA的平均含量3.1×105拷贝/ml,,阳性率17%.结论 乙型肝炎病毒e抗原阳性并不说明体内病毒复制一定活跃.经治疗后,病毒复制下降,部分患者e抗原仍阳性,e抗原何时消失有待进一步研究.血清学标志与HBV复制状态存在不一致性,兼顾内、外标两种PCR方法检测HBV-DNA更客观.

Correlation of hepatitis B e antigen with hepatitis B virus DNA in the serum of chronic hepatitis B patients after treatment

OBJECTIVE: To analyze the correlation of hepatitis B virus (HBV) DNA with the serological markers of HB in the serum of chronic HB patients after treatment PCR method and to analyze the status of these markers and the multiplication of virus. METHODS: Peripheral blood samples were collected from 480 chronic HB patients, aged 15 - 50, who had been treated by anti-nucleotide drugs or traditional Chinese herbs and showed normal ALT/AST. Both COBAS AMPLICOR HBV MONIORTM kit (internal-standard PCR method) and Light Cycler real time fluorescent quantitative PCR instrument (external-quantitative standard PCR method) were used to measure the HBV DNAS level. 42 of the 312 patients with the HBV DNA level lower than the minimum test limit measured by COBAS AMPLICOR HBV MONIORTM kit and HBeAg positive (>4 S/CO) underwent microparticle enzyme immunoassay (MEIA) to test the HBsAg, anti-HBs, HBeAg, anti-HBe, and HBcIgG. RESULTS: Seven of the 42 patients with HBV DNA negative measured by COBAS AMPLICOR HBV MONIORTM kit lower then the minimum test limit were shown as HBV DNA positive by Light Cycler real time fluorescent quantitative PCR. The 42 patients were HBsAg (+), anti-HBs (-), HBeAg (+), anti-HBe (-), and anti-HBcIgG (-), with an average HBeAg level of 42.26 S/CO and a positive HBeAg rate of 13.46%. CONCLUSION: HBeAg positivity does not necessarily means an active multiplication of HBV. The changes of the serological markers of HBV may be not consistent with that of HBV DNA. It is more objective to undergo both internal-standard and external-quantitative standard methods.