慢性HBV感染自然史各期肝组织HBcAg演变规律的探讨

目的：通过观察肝组织HBcAg分布在慢性HBV感染自然史各期的演变，进一步揭示HBV感染过程中免疫状态的规律。方法按照《慢性乙型肝炎防治指南（2010年版）》描述的慢型乙型肝炎自然史分期的血清学特征，将慢性HBV感染者分为免疫耐受期、免疫清除期、非活动或低（非）复制期以及再活动期。分别统计慢性HBV感染各个阶段肝组织HBcAg分布的情况。结果共纳入637例患者，其中男性501例（78.6%），女性136例（21.4%）。处于免疫耐受期患者101例，免疫清除期248例，非活动或低（非）复制期119例，再活动期169例。各阶段患者肝组织HBcAg分布差异均具有统计学意义（χ2=347.975，P ＜0.0001）。免疫耐受期肝组织HBcAg分布以核型与混合型为主（89.1%）；免疫清除期以混合型与浆型为主（74.6%）；非活动或低（非）复制期以阴性为主（89.1%）；再活动期以浆型与阴性为主（73.4%）。结论在慢型乙型肝炎自然史过程中，肝组织HBcAg经过了以核型为主→浆型为主→阴性→浆型为主的规律性变化。HBcAg的分布特征是HBV自然史阶段中机体免疫功能与病毒之间相互作用的重要标志。

Study on evolution rules of pattern of intrahepatic HBcAg distribution at different phases of the natural history in HBV infection

ObjectiveTo studyonthe changes of the pattern of intrahepatic HBcAg distribution at different phases ofpatients withchronic HBV infection,and further to reveal the immune rules of the HBV infection.MethodsPatients with conifrmed chronic HBV infection were included in this study.Referring to Guidelines for Chronic Hepatitis B in China （version 2010）,participants were classiifed into four phases, detailed as immune tolerant phase, immune clearance phase, low or non-replicative phase and reactivation phase. The pattern of intrahepatic HBcAg distribution at different phases of chronic HBV infection were analyzed.Results Total of 637 patients were recruited,including501 （78.6%） males and 136 （21.4%） females. Therewere 101 patients at immune tolerant phase, 248 patients at immune clearance phase, 119 patients at low or non-replicative phase and 169 patients at reactivation phase, respectively. The signiifcant difference was determined in the distribution types of HBcAg among the four phases （χ2=347.975,P〈0.0001）. The main patterns of HBcAg distribution in the liver were nucleic type plus mixed type （89.1%）, cytoplasmic type plus mixed type （74.6%）, negative type （89.1%）and cytoplasmictype plus negative type （73.4%） in the four phases,respectively. ConclusionsThe pattern of HBcAg distribution changed from the nucleic to cytoplasmic to negative to cytoplasmic during the natural history of chronic HBV infection.The pattern of HBcAg distribution, in some way, may act as an important indicator of the phase of chronic HBV infection.