E抗原和E抗体阳性的慢性乙型肝炎组织病理学研究

目的探讨HBeAg阳性和抗-HBe阳性的慢性乙型肝炎患者的肝组织病理改变的差异性.方法分别对151例HBeAg阳性和62例抗-HBe阳性的慢性乙型肝炎患者进行肝活检,观察肝组织病理分级和分期情况,同时检测血清HBV DNA.结果 (1)肝组织病理分级、分期与血清HBeAg/抗-HBe的出现情况密切相关,抗-HBe阳性者中肝组织病理为G3～G4、S3～S4者明显多于G1～G2、S1～S2者;而在HBeAg阳性者中则相反;两组比较差异有显著性(P＜0.005);(2)在HBeAg阳性患者中HBV DNA检出率为83.4%(126/151);而在抗-HBe阳性患者中HBV DNA检出率为29%(18/62).结论 (1)抗-HBe阳性的慢性乙型肝炎患者中肝组织炎症、坏死及肝纤维化的程度较HBeAg阳性者严重;(2)HBeAg与HBV DNA存在良好的相关性,但在部分抗-HBe阳性的患者中仍可检出HBV DNA.

Pathological changes between HBeAg and anti-Hbe in patients with chronic hepatitis B

OBJECTIVE: To observe the differences of pathological changes between HBeAg and anti-HBe in chronic hepatitis B. METHODS: Liver biopsy was performed in patients with chronic hepatitis B. The histopathological grading and staging were carried out. Serum markers of viral hepatitis were tested. RESULTS: (1) The histopathological grading and staging were closely correlated with the appearance of serum HBeAg and anti-HBe. The number of G(3-4) and S(3-4) in anti-HBe cases was significantly higher than that of G(1-2) and S(1-2), respectively. The number of G(1-2) and S(1-2) in HBeAg cases was significantly higher than that of G(3-4) and S(3-4), respectively. Significant differences were found between the group of anti-HBe cases and the group of HBeAg cases (P<0.005). (2) HBV DNA was detected in 126 of 151 HBeAg positive patients (83.4%), and the positive rate of HBV DNA in anti-HBe positive patient was 29% only. CONCLUSIONS: (1) Severe inflammatory, necrosis and fibrosis of hepatic tissue are observed in patients with anti-HBe positive chronic hepatitis B. (2) Although HBV DNA is positively correlated to HBeAg, HBV-DNA can be detected in part of anti-HBe positive patients.