乙型肝炎相关性肝衰竭患者HBV DNA低水平复制及特异性抗体表达的临床意义

目的探讨乙型肝炎相关性肝衰竭患者血清HBV DNA低水平复制及HBV特异性抗体表达的相关因素及临床意义。方法收集2008年6月至2013年12月于天津市第二人民医院住院治疗的391例乙型肝炎相关性肝衰竭患者及394例慢性乙型肝炎患者的病历资料。比较乙型肝炎相关性肝衰竭与慢性乙型肝炎患者HBV DNA表达的不同及影响因素分析。根据HBV血清学标志物(HBV M)特异性表达的不同将肝衰竭患者分为特异性抗体阳性(指抗-HBs、抗-HBe和抗-HBc同时阳性)和特异性抗体阴性(无抗-HBs、抗-HBe和抗-HBc同时阳性)2组,分析2组患者HBV DNA水平的变化和生存情况。组间比较采用独立样本t检验或MannWhitney秩和检验,计数资料比较采用χ2检验。结果乙型肝炎相关性肝衰竭患者HBV DNA水平低于慢性乙型肝炎组,差异有统计学意义(Z=-16.469,P0.05);HBeAg阳性和阴性的肝衰竭患者HBV DNA水平均低于相应的慢性乙型肝炎患者,差异有统计学意义(Z分别为-11.665和-12.853,P0.05)。在391肝衰竭病例中,HBV特异性抗体阳性组29例(7.42%),死亡25例(86.21%),HBV特异性抗体阴性组362例(92.58%),死亡157例(43.37%),2组病死率差异有统计学意义(P0.05)。特异性抗体阳性组患者HBV DNA水平明显低于特异性抗体阴性组,差异有统计学意义(Z=-3.594,P0.05)。2组HBeAg阴性患者HBV DNA水平均低于HBeAg阳性患者,差异有统计学意义(Z分别为7.427和7.513,P0.05)。结论 HBV M表达形式及机体免疫状态的动态变化在乙型肝炎相关性肝衰竭的发生发展过程中起着一定作用,HBV DNA低水平复制系机体处于免疫清除期所致,而同时伴抗-HBs、抗-HBe、抗-HBc 3个抗体同时阳性则提示机体对HBV的超强免疫反应,致使病情恶化、发展迅速,病死率高。

Clinical significance of low-level HBV DNA replication and specific antibody expression in patients with HBV-re-lated liver failure

Objective To investigate the influential factors and clinical significance of low-level hepatitis B virus （HBV）DNA replication and specific antibody expression in patients with HBV-related liver failure.Methods A retrospective analysis was performed on the medi-cal records of 39 1 patients with HBV-related liver failure and 394 patients with chronic hepatitis B （CHB）hospitalized in the Tianjin Sec-ond People′s Hospital from June 2008 to December 2013.The HBV DNA level was compared between patients with HBV-related liver fail-ure and those with CHB,and the influential factors were analyzed.According to the expression of HBV serum markers （HBV-Ms）,pa-tients with liver failure were divided into specific antibody-positive group （positive for anti-HBs,anti-HBe or anti-HBc）and specific antibody-negative group （negative for anti-HBs,anti-HBe or anti-HBc）.The changes in HBV DNA level and survival were compared between the two groups.Between-group comparison was made by independent-samples t test or Mann-Whitney rank sum test,and com-parison of enumeration data was made by chi-square test.Results The patients with HBV-related liver failure had a significantly lower HBV DNA level than the CHB patients （Z=-16.469,P〈0.05）.The levels of HBV DNA in HBeAg-positive and -negative patients with liver failure were significantly lower than those in patients with CHB （Z1 =-11.665,P〈0.05;Z2 =-12.853,P〈0.05）.Of the 391 patients with HBV -related liver failure,29 （7.42%）were specific antibody -positive,and 25 （86.21%）of them died;362 （92.58%）were specific antibody-negative,and 157 （43.37%）of them died.There was a significant difference in mortality between the specific antibody-positive and specific antibody-negative groups （P〈0.05）.The specific antibody-positive group had a significantly lower HBV DNA level than the specific antibody-negative group （Z=-3.594,P〈0.05）.For either group,the HBV DNA level was sig-nificantly lower in HBeAg-negative patients than in HBeAg-positive patients （Z=7.427 or 7.513,P〈0.05）.Conclusion HBV Mex-pression and the body′s immune status play a role in the progression of HBV-related liver failure.HBV DNA replication is at a low level in the immune clearance phase.Being positive for anti-HBs,anti-HBe,and anti-HBc suggest a super immune response to HBV,leading to rapid progression of disease and high mortality.