HBeAg状态及乙型肝炎病毒载量对慢性重型乙型肝炎预后的影响

目的 探讨HBeAg状态及HBV DNA载量对慢性重型乙型肝炎预后的影响.方法 回顾分析2002年1月至2007年12月在南方医科大学南方医院住院的慢性重型乙型肝炎患者406例,研究HBeAg状态、HBV DNA载量对疾病预后的影响.计量资料采用t检验,率的比较采用X2检验.结果 406例重型肝炎患者中,HBeAg阳性208例,占51.2%,HBeAg阴性198例,占48.8%.HBeAg阳性组与HBeAg阴性组比较,两组间男女构成比、TBil峰值及平均凝血酶原活动度谷值差异均无统计学意义;HBeAg阴性组平均年龄(46.7±12.8)岁,显著高于HBeAg阳性组(38.3±13.5)岁(t=6.43,P＜0.01);HBeAg阴性组肝硬化患者占67.7%,亦显著高于HBeAg阳性组的45.7%(X2=19.97,P＜0.01);HBeAg阴性组好转率为32.3%,显著低于HBeAg阳性组的44.7%(X2=6.56,P＜0.05).在208例HBeAg阳性与198例HBeAg阴性患者中,均显示随着HBV DNA载量的升高,其好转率下降,呈显著负相关(X2=22.98,X2=26.04;均P＜0.01).结论 HBeAg阴性重型乙型肝炎较HBeAg阳性者预后差;无论HBeAg状态如何,HBV DNA载量越高,其预后越差.

The impact of HBeAg states and hepatitis B virus DNA loads on the prognosis of chronic severe hepatitis B

Objective To evaluate the impact of hepatitis B e antigen (HBeAg) states and hepatitis B virus DNA loads on the prognosis of chronic severe hepatitis B.Methods A total of 406 hospitalized patients with chronic severe hepatitis B in Nanfang Hospital of Southern Medical University from January 2002 to December 2007 were retrospectively analyzed.The impact of HBeAg states and HBV DNA loads on the prognosis was evaluated.The measurement data were compared by t test and rates were compared by chi square test.Results Of all the 406 patients with chronic severe hepatitis B,208 (51.2%) patients were HBeAg-positive and the remaining 198 (48.8%) were HBeAgnegative.There was no significant difference of constituent ratio of male and female,average peak value of total bilirubin and average valley value of prothrombin activity between HBeAg-positive group and HBeAgnegative group.However,the average age of HBeAg-negative patients was (46.7±12.8) years old,which was significantly higher than that (38.3±13.5) years old in HBeAg-positive group (t = 6.43,P＜0.01 )the proportion of patients with liver cirrhosis in HBeAg-negative group (67.7%) was much higher than that in HBeAg-positive group (45.7%) (X2=19.97,P＜0.01);the improved rate in HBeAg-negative group (32.3%) was significant lower than that in HBcAg-positive group (44.7%) (X2=6.56,P＜0.05).Increasing HBV DNA levels was associated with lower improved rate in both 208 HBeAg-positive and 198 HBeAg-negative patients(X2=22.98,26.04,respectively,both P＜0.01 ).Conclusions HBeAg-negative patients with chronic severe hepatitis B has worse prognosis than HBeAg-positive patients;and the prognosis is getting worse with the increasing HBV DNA level regardless of the HBeAg status.