高灵敏度HBV DNA检测指导慢性乙型肝炎患者抗病毒治疗的临床意义

目的探讨高灵敏度HBV DNA检测对于指导HBV DNA低载量慢性乙型肝炎（CHB）患者抗病毒治疗的临床意义。 方法收集应用国产试剂检测结果低于检测下限（< 10³ IU/ml）的拟停药组112例患者和拟用药组48例患者共160份血清标本采用COBAS Amplicor系统再次进行检测，并与HBsAg定量结果进行对照分析。 结果经国产试剂检测结果低于检测下限（<10³ IU/ml）的160份血清经COBAS Amplicor系统再次检测有52例（32.50%）标本HBV DNA > 10³ IU/ml，高于高灵敏度HBV DNA检测下限（20 IU/ml）的标本共115份（占71.88%）。拟停药组患者HBV DNA≥ 20 IU/ml者有72例（占64.29%）；拟用药组患者中有19例HBV DNA> 10³ IU/ml，43例≥ 20 IU/ml（占89.58%）。应用COBAS试剂检测HBV DNA不同载量组别与HBsAg浓度对数值均呈显著正相关（P < 0.01）。 结论对国产试剂检测HBV DNA低载量患者应进一步做高灵敏的定量PCR试剂检测，可更好地指导患者初始应用或停用核苷（酸）类药物。

The clinical significance of high sensitivity HBV DNA detection for the treatment of antiviral therapy in patients with chronic hepatitis B

ObjectiveTo investigate the clinical significance of the high sensitive HBV DNA detection for the antiviral treatment of the chronic hepatitis B (CHB) patients with HBV DNA low viral load. MethodsTotal of 160 sera specimens separated from 112 cases of quasi discontinuation group which were detected lower than the detection line (< 10³ IU/ml) and 48 cases of quasi treatment group detected by domestic reagent were tested again using COBAS Amplicor system and compared with the results of quantitative HBsAg. ResultsThere were 52 (32.5%) cases with HBV DNA quantitative value > 10³ IU/ml by Amplicor COBAS system out of 160 serum samples lower than the detection line (10³ IU/ml) detected by domestic reagent, 115 (71.88%) samples were detected higher than the high sensitive HBV DNA detection line (20 IU/ml). And 72 (64.29%) cases of the withdrawal group were detected than 20 IU/ml; in the treatment group, 19 cases were detected higher than 10³ IU/ml, 43 (89.58%) cases were detected ≥ 20 IU/ml in quasi treatment group. There was a significant positive correlation between different HBV DNA load groups by COBAS reagent detection and HBsAg concentration logarithm value (P < 0.01). ConclusionsHigh sensitive quantitative PCR should be furtherly conducted for HBV DNA low load patients to guide the initial application or discontinuation of nucleos(t)ide drugs.