不同HBeAg状态乙型肝炎慢加急性肝衰竭的临床特点比较

目的探讨HBeAg阳性和HBeAg阴性乙型肝炎相关性慢加急性肝衰竭的临床特点。方法回顾性分析2008年12月～2010年12月在本科住院的150例乙肝慢加急性肝衰竭患者,对HBeAg阳性和HBeAg阴性患者的生化学、血清学、病毒学及预后进行统计分析。结果 HBeAg阳性及阴性慢加急性肝衰竭患者的平均年龄分别为（39.9±9.2）岁与（46.4±12.7）岁,两者差异有统计学意义（P=0.004）;两组之间AST、ALT、总胆红素、清蛋白、总胆固醇、胆碱酯酶、血清肌酐、凝血酶原活动度等水平无统计学差异;HBeAg阳性组好转率为35.0%（14/40）、HBeAg阴性组为36.4%（40/110）（P=0.519）;两组的HBsAg定量、HBV-DNA定量无统计学差异;低病毒载量（HBeAg阳性组HBV DNA〈20000IU/mL,HBeAg阴性组HBV DNA〈2000IU/mL）组与高病毒载量（HBeAg阳性组HBV DNA〉20000IU/mL,HBeAg阴性组HBV DNA〉2000IU/mL）组好转率分别为11.5%（3/26）、43.0%（49/114）（P=0.002）。结论不同HBeAg的乙型肝炎慢加急性肝衰竭患者生化学、血清学改变及预后无明显差异,但HBV DNA载量可能对预后有影响。

Comparison of the clinical features of HBV induced acute-on-chronic liver failure with different HBeAg status

Objective To explore the clinical features of hepatitis B virus(HBV) induced acute-on-chronic liver failure(ACLF).Methods One hundred and fifty cases of hepatitis B induced acute-on-chronic liver failure were retrospective analyzed in December 2008 to December 2010 in our department,the HBeAg positive and HBeAg negative for patients with biochemistry,serologic,virology and prognosis of statistical analyzed.Results HBeAg positive and negative slow and acute liver failure the median age of the patients were(39.9±9.2) years old and(46.4±12.7) years old,the difference were statistically significant in both(P = 0.004).The AST,ALT,total bilirubin,albumin,total cholesterol,cholinesterase,serum creatinine,prothrombin activity levels were not statistically different between the two groups;The recovery rate was 35.0%(14/40) in HBeAg positive group,HBeAg negative group was 36.4%(40/110)(P = 0.519).The HBsAg quantitative,HBV-DNA ration were no statistical difference between the two groups;Low viral load(HBeAg positive group of HBV DNA < 20 000 IU/mL,HBeAg negative groups HBV DNA < 2 000 IU/mL) group and high viral load(HBeAg positive group of HBV DNA > 20 000 IU/mL,HBeAg negative groups HBV DNA > 2 000 IU/mL) of the central group were 11.5%(3/26),43.0%(49/114)(P = 0.002).Conclusion There are no significant differences of the biochemistry,HBV serology and disease prognosis in the HBV induced ACLF patients with different HBeAg status,but the viral load may have impact on the prognosis.