HBeAg阴性慢性乙型肝炎生化、病毒学及病理特征探讨

目的探讨HBeAg阴性慢性乙型肝炎患者的病毒学、生化、病理等特点及它们之间的关系。方法对143例HBeAg阴性慢性乙型肝炎患者采用荧光定量聚合酶链反应进行血清HBV—DNA定量检测，并进行肝组织活检，病理炎症、纤维化分级。对其临床资料、ALT、HBV—DNA及肝脏病理组织进行相关性分析。结果22例HBV—DNA低于检测下限[（1．00E＋03）copies／mL]的慢性乙型肝炎患者仍存在炎症活动及纤维化。121例HBeAg阴性慢性乙型肝炎患者的HBV—DNA载量与ALT、炎症活动度、纤维化分级均呈正相关（rs=0．513，P〈0．01；rs=0．545，P〈0．01;rs=0．408，P〈0．01），年龄与纤维化分级亦呈正相关（rs=0．277，P〈0．01）。结论对ALT有波动的HBeAg阴性慢性乙型肝炎患者应尽可能进行肝穿刺活组织检查，以便更好地指导治疗。

An Analysis of Biochemical, Viral, Pathologic Features in HBeAg-negative Chronic Hepatitis Infected with Virus B

Objective To investigate retrospectively the biochemical, viral, pathologic features and the relationship between them in HBeAg-negative chronic hepatitis B（CHB）. Methods HBV DNA level was assayed by fluorescent quantitative polymerase chain reaction（FQ-PCR） in 143 patients. Liver biopsy was performed and the grading and staging of liver tissues were routinely obtained. The serum ALT values, HBV-DNA levels,hepatic inflammation and fibrosis were analyzed. Results There were still inflammatory activity and fibrosis in 22 cases of CHB patients with HBV-DNA levels below the detection limit[（1.00E ＋ 03）copies/roLl. There was obvious positive correlation between serum HBV-DNA and serum ALT values or inflammatory activity or fibrosis staging（rs=0. 513 ,rs=0. 545 ,rs=0. 408;all P〈0.01）. There was also a significant positive correlation between age and fibrosis staging（rs=0. 277, P〈0. 01）. Conclusion Liver biopsy and pathological examination should be carried out in HBeAg-negative chronic hepatitis B with serum ALT fluctuations for better instruction treatment.