慢性乙型肝炎患者12周自发性HBV DNA水平变化分析

目的 分析慢性乙型肝炎患者12周内自发性HBV DNA水平下降情况.方法 回顾性分析2003-2005年未接受抗病毒药物治疗的慢性乙型肝炎患者12周内自发性HBV DNA水平下降情况,并根据患者基线ALT、总胆红素(TBil)水平进行分组,分析基线ALT、TBil对自发性HBVDNA水平下降的影响.两组间计量资料比较采用t检验或Wilcoxon符号秩和检验;多组数据均值比较采用方差分析;组间率的比较采用x2检验.结果 共收集213例慢性乙型肝炎患者,男性174例,女性39例,年龄18～65(33.0±10.0)岁.其中慢性乙型肝炎轻～中度124例,慢性乙型肝炎重度89例;12周时失访19例(8.92%).所有患者HBV DNA基线均值为(6.66±1.03)log10拷贝/ml,12周时为(5.98±1.53)log10拷贝/ml(P<0.01).慢性乙型肝炎重度患者基线时HBVDNA水平均值低于慢性乙型肝炎轻～中度患者,分别为(6.45±0.99)log10拷贝/ml与(6.81±1.04)log10拷贝/ml(P<0.05);但两组12周时HBV DNA水平均值及HBV DNA水平下降值的差异均无统计学意义.12周时HBV DNA≤3 log10拷贝/ml患者的基线ALT及TBil值高于HBVDNA>3 log10拷贝/ml组,但差异均无统计学意义.12周时HBV DNA水平下降值≥2 log10拷贝/ml与<2 log10拷贝/ml两组患者的基线ALT、TBil水平相近(P>0.05).基线ALT水平≤5倍正常值上限(ULN)与>5×ULN两组患者12周时HBV DNA水平均值及HBV DNA水平下降值的差异均无统计学意义;两组患者12周时HBV DNA≤3 log10拷贝/ml、HBV DNA水平下降值≥2 log10拷贝/ml的比例,差异也无统计学意义(P>0.05).基线时ALT≤5 × ULN及TBil≤5×ULN组HBV DNA水平均值高于其他3组(P<0.05),但12周时各组HBV DNA水平均值、HBV DNA下降值比较,差异无统计学意义. 结论 慢性乙型肝炎患者12周内存在一定程度的自发性HBV DNA水平下降,但肝脏炎症损伤程度与患者12周内自发性HBV DNA水平下降程度无明显的相关性.

Analysis of spontaneous decline of HBV DNA in chronic hepatitis B patients in 12 weeks

Objective To analyze the spontaneous decline of HBV DNA in chronic hepatitis B patients in 12 weeks. Methods Chronic hepatitis B patients not receiving antiviral treatment from 2003 to 2005 were divided into two groups according to the baseline value of ALT and TBil. Spontaneous decline of HBV DNA were retrospected, and the influence of the baseline value of ALT and TBil on spontaneous decline of HBV DNA was analyzed. Results Total of 213 chronic hepatitis B patients (male 174, female 39, aged from 18 to 65) were recruited in this study, in cluding 124 mild and moderate type of hepatitis B, 89 severe type of hepatitis B, and 19 patients (8.92%) were lost at the end of the 12th week. The mean baseline value of HBV DNA of all the patients was (6.66 ± 1.03) logio copies/ml, at 12 week the mean value of HBV DNA of all the patients was (5.98 ± 1.53) logio copies/ml (compared to baseline P < 0.01), the decline value of HBV DNA was (0.68 ± 1.46) logio copies/ml.The mean baseline value of HBV DNA of patients with the severe type of hepatitis B was lower than that with the mild or moderate type of hepatitis B patients [(6.45 ± 0.99) logio copies/ml and (6.81 ± 1.04) log10 copies/ml respectively] (P < 0.05). However; there was no significant difference in the mean and the declined value of HBV DNA between these two groups at the 12th week (P > 0.05). At the 12th week, the baseline values of ALT and TBil were higher in patients with HBV DNA ≤3 logio copies/ml than those in patients with HBV DNA > 3 logio copies/ml (P > 0.05); And there were no significant difference in the baseline values of ALT and TBil between patients with the declined value of HBV DNA ≥ 2 logio copies/ml and patients with declined value of HBV DNA < 2 logio copies/ml. At the 12th week, the mean and the declined value of HBV DNA were similar between the patients with ALT ≤5 × ULN and the patients with ALT > 5 x ULN at baseline. The mean baseline value of HBV DNA of patients in the group of patients whose baseline value of ALT ≤ 5 × ULN while TBil ≤ 5×ULN was higher than that in the group of patients whose baseline value of ALT>5 × ULN while TBil > 5 × ULN, ALT ≤5 ×ULN while TBil>5×ULN,ALT>5 ×ULN while TBil ≤ 5 ×ULN (P < 0.05 respectively), there were no significant difference in the rate of the HBV DNA ≤ 3 logio copies/ml and the rate of the decling value of HBV DNA ≥ 2 logio copies/ml between the groups at 12 week (P > 0.05 respectively). Conclusions There is spontaneous decline of HBV DNA in patients with chronic hepatitis B in 12 weeks, but the level of liver injury is not correlated with the level of spontaneous decline of HBV DNA in chronic hepatitis B patients in 12 weeks.