慢性乙型肝炎免疫清除期甲胎蛋白与HBV DNA清除的相关性研究

目的：探讨乙型肝炎免疫清除期，甲胎蛋白（AFP）与HBV DNA清除之间的相关性。方法收集处于免疫清除期发病2周内AFP升高5倍以上患者共58例，分为非抗病毒治疗组（下称观察组）31例和核苷（酸）类似物抗病毒治疗组（下称阳性对照组）27例，另取同期住院AFP阴性首次发病的慢性乙型肝炎核苷（酸）类似物抗病毒患者30例作为阴性对照组。分析影响HBV DNA清除率的相关因素。结果阳性对照组及阴性对照组患者均行抗病毒治疗，HBV DNA定量与各临床数据之间均无相关性，观察组HBV DNA定量与各指标之间的关系结果显示，AFP与HBV DNA清除具有显著相关性（r=0.8420，P=0.018），以下依次为ALT（r=0.7888，P=0.027）和总胆红素（TBil）（r=0.7816，P=0.032）。HBsAg（r=0.0480，P=0.413）和HBeAg（r=0.3356，P=0.191）与HBV DNA清除无显著相关性。结论对乙型肝炎免疫清除期AFP升高5倍以上患者，可先进行密切病情观察，根据病情需要进行抗病毒治疗。

Correlation between serum alpha-fetoprotein level and HBV DNA clearance in immune clearance phase of patients with chronic hepatitis B

Objectives To investigate the relationship between serum alpha-fetoprotein level and HBV DNA clearance in immune clearance phase of patients with chronic hepatitis B （CHB）. Methods Total of 58 cases with CHB, who were in immune clearance phase and the serum alpha-fetoprotein level〉5 upper limits of normal in two weeks since disease onset were enrolled. Among which 31 cases received non-antiviral therapy as experimental group, and 27 cases received antiviral therapy as positive control group. While other 30 cases with CHB who were in immune clearance phase and the serum alpha-fetoprotein level were normal in two weeks since disease onset, were enrolled as negative control group. And the correlation factors of HBV DNA clearance were analyzed, respectively. Results There were no signiifcant correlation between HBV DNA clearance and other data in patients who received antiviral therapy in positive and negative control group. In experimental group, there were positive correlation between HBV DNA clearance and serum alpha-fetoprotein level （r=0.8420, P=0.018）, and inturn were alanine aminotransferase （r=0.7888, P=0.027）, total bilirubin （TBil） （r=0.7816, P=0.032）, but there were no signiifcant correlation among HBV DNA clearance with HBsAg （r=0.0480, P=0.413） and HBeAg （r=0.3356, P=0.191）. Conclusions Patients with CHB who were in immune clearance phase and the serum alpha-fetoprotein level 〉5 upper limits of normal, might be close surveyed ifrstly, and might be given antiviral therapy when need.