乙型肝炎肝硬化患者乙型肝炎病毒DNA水平与肝纤维化程度的关系

目的 探讨乙型肝炎肝硬化患者乙型肝炎病毒(HBV)DNA水平与肝纤维化程度的关系及其临床意义.方法 回顾性分析2004年至2006年本科室收治的263例乙型肝炎肝硬化住院患者的临床资料.所有患者均进行肝功能Child-Pugh分级,检测HBV DNA、HBV血清标志物、透明质酸(HA)、人Ⅲ型前胶原(Hpc-Ⅲ)、Ⅳ型胶原(Ⅳ-C)、层粘蛋白(LN);行腹部超声检测脾大小、门静脉内径、脾静脉内径;胃镜检查食管静脉曲张程度,并记录常见并发症.根据HBV DNA水平分为4组:G1组,HBV DNA＜103拷贝/ml;G2组,HBV DNA 103～＜105拷贝/ml;G3组,HBV DNA 105～＜107拷贝/ml;G4组,HBV DNA≥107拷贝/ml.比较各组间Child-Pugh分级、肝纤维化血清指标和门脉高压指标的差异以及各组肝硬化常见并发症的发生情况.结果 263例患者中217例(82.5%)HBV DNA阳性.不同HBV DNA水平患者之间的Child-Pugh评分分级、HA、Hpc-Ⅲ、Ⅳ-C、LN比较,差异无统计学意义(均P＞0.05).4组患者之间脾大小、门静脉内径、脾静脉内径及食管静脉曲张程度比较,差异无统计学意义(均P＞0.05).4组患者并发症如消化道出血、继发感染、腹水、肝性脑病、肝癌等发生率差异也无统计学意义(均P＞0.05).结论 绝大部分乙型肝炎肝硬化患者HBV DNA阳性,但血清HBV DNA水平高低与肝硬化严重程度及并发症的发生率无明显关联.

Relationship between HBV DNA level and degree of liver fibrosis in hepatitis B patients with cirrhosis

Objective To examine the relationship and its clinical significance between hepatitis B virus (HBV) DNA level and the degree of liver fibrosis in patients with hepatitis B liver cirrhosis. Methods A total of 263 hospitalized patients with type B hepatitis and liver cirrhosis, registered to our department between 2004 and 2006, were investigated retrospectively. All the patients underwent Child- Pugh classification of liver function, tests of HBV DNA, serum HBV markers, hyaluronic acid (HA), human type Ⅲ procollagen (Hpc- Ⅲ ), type Ⅳ collagen ( Ⅳ -C) and laminin (LN), besides, abdominal ultrasound scanning was performed to measure the size of spleen, internal diameters of portal vein and splenic vein.Gastroscopy was used for evaluating esophageal varices, and common complications were recorded. The patients were divided into four groups according to HBV DNA levels, HBV DNA ＜ 103 copies/ml (G1), HBV DNA 103 to＜ 105 copies/ml (G2), HBV DNA 105 to＜ 107 copies/ml (G3) and HBV DNA≥ 107 copies/ml (G4). Differences in Child-Pugh classification, serum markers of liver fibrosis and portal hypertension index between groups were compared, and so were common complications of liver cirrhosis in each group.Results Out of 263 cases, 217(82.5%) were with positive HBV DNA. There were no statistical differences in Child-Pugh classification, HA, Hpc-Ⅲ, Ⅳ-C or LN among patients with various HBV DNA levels (all P＞0.05), nor in spleen size, internal diameters of portal vein and splenic vein, degree of esophageal varices among the four groups (all P＞0.05). The incidences of complications such as gastrointestinal bleeding,secondary infection, ascites, hepatic encephalopathy and liver cancer did not differ among the four groups either (all P＞0.05). Conclusion While HBV DNA in most hepatitis B patients with cirrhosis are positive,there is no obvious correlation between serum HBV DNA level and severity of cirrhosis or incidence of complications.