慢性乙型肝炎1 646例肝脏组织学病变与血清HBV-DNA定量关系的研究

目的　观察慢性乙型肝炎 (CHB)肝脏病变程度与血清HBV DNA定量水平的关系。方法　对 1 646例CHB以Menghini法行肝脏穿刺活体组织学检查和应用荧光定量聚合酶链反应 (FQ PCR)技术进行血清HBV DNA定量检测,其中 142例CHB患者于 0 5~8年后再次行肝脏穿刺活体组织学检查,并将其肝脏病变与血清HBV DNA定量的关系进行了近期及远期动态观察。结果　血清HBeAg阳性的CHB患者肝脏病变程度与血清HBV DNA定量水平并不相关 (P>0 05 ),但HBeAg阴性患者则显著相关 (P<0 05 )。动态观察显示无论HBeAg阳性与阴性的CHB患者,血清HBV DNA定量持续高水平者其远期肝脏病变较降为低水平的CHB患者明显加重 (P<0. 05 )。结论　血清HBV DNA定量水平可作为HBV DNA阴性CHB患者肝脏病变程度的有效预测指标。血清HBV DNA定量持续高水平的CHB患者预后差。抗病毒治疗是CHB患者的治疗关键。对CHB患者动态复查血清HBV DNA定量有助于预测远期预后。

Study on the Relationship between HBV DNA Quantitation in Serum and Hepatic Pathological Change of 1 646 Patients with Chronic Hepatitis B

Objective To observe the relationship between HBV DNAL quantitation in serum and hepatic pathological change in the patients with chronic hepatitis B (CHB). Methods A total of 1,646 patients with CHB were enrolled in this study. Liver biopsy by Menghini's method and quantitative detection of HBV DNA in serum by a real-time fluorescence polymerase chain reaction (PCR) assay were performed on all the patients. Among them, 142 patients were performed liver biopsy twice with an interval of 0.5~8 years, and their hepatitis B viruses (HBV) DNA levels in sera were dynamically detected. Then the relationship between HBV DNA level in serum and short-term or long-term hepatic pathological change was comparatively analyzed. Results HBV DNA level in serum of CHB patients with negative HBeAg was closely correlated to the severity of hepatic pathological change (P<0.05), but that of the patients with positive HbeAg was not so (P>0.05). Dynamic observation indicated that the severity of long-term hepatic pathological change of CHB patients with persistent high level of HBV DNA in serum was more significant than that of those with comparatively low level of HBV DNA quantitation (P<0.05).Conclusion Viral load is an effective predictive factor for severity of hepatic pathological change in CHB patients with scrum HBeAg negativity. Poorer prognosis belongs to those with persistent high viral load. Dynamic detection of HBV DNA quantitation in serum is helpful to the prediction of the prognosis of CHB patients. CHB patients with negative or positive serum HBeAg should be duly received antiviral therapy.