HBeAg阳性与HBeAg阴性慢性重型乙型肝炎死亡患者的临床特征比较

目的探讨HBeAg阳性与HBeAg阴性慢性重型乙型肝炎患者的临床特征。方法对95例慢性重型乙型肝炎患者的临床资料、肝功能、肝纤维化指标、HBVDNA载量及并发症发生率进行回顾性分析。结果95例患者中，HBeAg阳性41例（43％），HBeAg阴性54例（57％）。HBeAg阳性组与HBeAg阴性组平均发病年龄，ALB、TB、CHE、肝纤维化指标及肝衰竭并发症发生率差异无统计学意义（P〉0．05）。HBeAg阴性患者的ALT、AST分别为（400．37±413．59）U／L和（578．14±600．23）U／L，高于阳性患者的（198．25±215．37）u／L和（254．78±269．16）U／L（P〈0．05）。HBeAg阳性患者的HBVDNA载量为（6．17×10^6±8．24×10^1）copies／ml高于阴性患者的（2．39×10^5±6．75×10^1）copies／ml，两组间具有显著差异（P〈0．05）。另外HBeAg阳性患者的左肝前后径及右肝厚度分别为（65．12±12．43）mm及（95．37±12．69）mm，均高于阴性患者的（56．78±11．04）mm和（89．34±9．23）mm（P〈0．05）。结论HBeAg阴性慢性重型乙型肝炎患者与HBeAg阳性患者相比在较低的HBVDNA载量下，仍引起较高的肝损伤和较大幅度的肝脏萎缩。

The clinical features in chronic severe hepatiti B patients with HBeAg-positive and HBeAg-negative

Objective To investigate the clinical characteristics in chronic severe hepatitis B patients with HbeAg-positive and HbeAs-negative.Methods A total of 95 chronic severe hepatitis B cases were retrospectively analyzed.The clinical information,hepatic function,hepatic fibrosis and HBV DNA in HBeAg-negative and HBeAgpositive groups were analyzed.Results of the 95 cases,54(57% ) were HBeAg-negative and 41(43% ) were HBeAg-positive.No significant differences were found on age,ALB,TB,CHE,indexes of hepatic fibrosis and the ratio of complications between HBeAg-negative group and HBeAg-positive group.Compared with HBeAg-positive group,there were significantly higher levels of ALT(198.25±215.37)U/L vs(400.37±413.59)U/L],AST(254.78±269.16)U/L vs(578.14±600.23)U/L] and lower level of HBV DNA(6.17×10~6±8.24×10~1)copies/ml vs (2.39×10~5±6.75×10~1) copies/ml] in HBeAg-negative group(P<0.05).The anteroposterior diameter of the left liver and the thickness of right liver were(65.12±12.43)mm and(95.37.±12.69)mm in the HBeAg positive fatal chronic severe hepatitis B before the terminal phase,vs(56.78±11.04)mm and(89.34.±9.23)mm in the HBeAg negative group,and the former is longer than the later(P<0.05).Conclusion Tissue injury is more serious and the level of HBV DNA is lower in HBeAg-negative patients than HBeAg-positive patients.Liver size of HBeAg negative group reduces more significantly than HBeAg positive group before terminal phase.