HBV DNA低水平患者的肝组织炎症活动度及相关因素分析

刘立; 刘春云; 杜映荣; 黄红丽; 陈洁; 罗煜; 李惠敏; 李卫昆; 李俊义; 岳云璇

doi:10.3969/j.issn.1001-5256.2019.01.014

HBV DNA低水平患者的肝组织炎症活动度及相关因素分析

DOI: 10.3969/j.issn.1001-5256.2019.01.014

1. 云南省昆明市第三人民医院肝三科
2. 云南省昆明市第三人民医院内科
3. 云南省昆明市第三人民医院药剂科

基金项目:

云南省科技厅应用基础研究项目(2017FH001-088)；昆明市科技局科技计划项目(2017KJJH252)；

详细信息

中图分类号: R512.62;R575
计量
- 文章访问数: 1393
- HTML全文浏览量: 8
- PDF下载量: 401
- 被引次数: 0
出版历程
- 收稿日期: 2018-08-16
- 出版日期: 2019-01-20

Liver inflammatory activity in chronic hepatitis B patients with a low HBV DNA level and related factors

Third Department of Hepatology, The Third People's Hospital of Kunming

Research funding:

摘要

摘要: 目的分析低水平HBV DNA患者肝组织炎症活动度与临床特征间的关系,为低水平HBV DNA患者的病情判断提供依据。方法收集2014年1月-2017年12月在云南省昆明市第三人民医院治疗HBV DNA水平低于2000 IU/ml且高于20 IU/ml患者137例,根据炎症活动分级分为G1组（n=44）、G2组（n=84）和G3组（n=9）。所有患者均进行肝穿刺活组织检查和肝组织免疫组化,分析炎症分级与患者年龄、性别、感染HBV时间、肝功能、HBsAg水平、HBV DNA载量、基因型、门静脉内径、脾静脉内径、脾脏厚度等的关系。等级资料多组间比较采用Kruskal-Wallis H检验。结果 137例患者中HBeAg阴性126例,其中G1 42例（33. 33%）,G2 77例（61. 11%）,G3 7例（5. 56%）; HBeAg阳性11例,G1 2例（18. 18%）,G2 7例（63. 64%）,G3 2例（18. 18%）。126例HBeAg阴性患者G1、G2、G3 3组间比较,Glo、HBV DNA、PLT、脾静脉内径和脾脏厚度比较差异均有统计学意义（H值分别为6. 189、7...
- 病毒载量 /
- 炎症活动度 /
- 病理学,临床
Abstract: Objective To investigate the association between liver inflammatory activity and clinical features in chronic hepatitis B (CHB) patients with a low HBV DNA level, and to provide a basis for judging the condition of such patients.Methods A total of 137 patients with an HBV DNA level of 20-2000 IU/ml who were treated in The Third People's Hospital of Kunming from January 2014 to December 2017were enrolled, and according to the grade of liver inflammatory activity, they were divided into G1 group with 44 patients, G2 group with 84patients, and G3 group with 9 patients.Liver biopsy and immunohistochemistry were performed for all patients, and the association of the grade of liver inflammatory activity with age, sex, HBV infection time, liver function, HBsAg level, HBV DNA load, genotype, diameter of the portal vein, diameter of the splenic vein, and spleen thickness was analyzed.The Kruskal-Wallis H test was used for comparison of nonparametric ranked data between multiple groups.Results Of all 137 patients, 126 had negative HBeAg, among whom 42 (33.33%) had G1 inflammation, 77 (61.11%) had G2 inflammation, and 7 (5.56%) had G3 inflammation;11 had positive HBeAg, among whom 2 (18.18%) had G1 inflammation, 7 (63.64%) had G2 inflammation, and 2 (18.18%) had G3 inflammation.There were significant differences in globulin, HBV DNA load, platelet count (PLT) , diameter of the splenic vein, and spleen thickness between the 126 HBeAg-negative patients with different inflammation grades (H=6.189, 7.168, 8.624, 8.170, and 8.522, all P<0.05) .Conclusion The majority of patients with a low HBV DNA level have≥G2 liver inflammation and the indication for antiviral therapy, and the grade of inflammation is closely associated with globulin, HBV DNA load, PLT, diameter of the splenic vein, and spleen thickness.
- viral load /
- inflammation grades /
- pathology, clinical

HTML全文

参考文献(25)

[1]GAO Y, LI Y, MENG Q, et al.Serum hepatitis B Virus DNA, RNA, and HBsAg:Which correlated better with intrahepatic covalently closed circular DNA before and after nucleos (t) ide analogue treatment?[J].J Clin Microbiol, 2017, 55 (10) :2972-2982.

[2]TRIPODI G, LARSSON SB, NORKRANS G, et al.Smaller reduction of hepatitis B virus DNA in liver tissue than in serum in patients losing HBe Ag[J].J Med Virol, 2017, 89 (11) :1937-1943.

[3]THOMPSON AJ, NGUYEN T, LSER D, et al.Serum hepatitis Bsurface antigen and hepatitis B e antigen titers:Disease phase influences correlation with viral load and intra-hepatic hepatitis Bvirus markers[J].Hepatology, 2010, 51 (6) :1933-1944.

[4]LARSSON SB, MALMSTROM S, HANNOUN C, et al.Mechanisms downstream of reverse transcription reduce serum levels of HBV DNA but not of HBsAg in chronic hepatitis B virus infection[J].Virol J, 2015, 12:213.

[5]OZDIL B, COSAR AM, AKKIZ H, et al.Negative correlation between viral load and HBsAg levels in chronic HBV-infected patients[J].Arch Virol, 2009, 154 (9) :1451-1455.

[6]BRUNETTO MR, OLIVERI F, COLOMBATTO P, et al.Hepatitis B surface antigen serum levels help to distinguish active from inactive hepatitis B virus genotype D carrier[J].Gastroenterology, 2010, 139 (2) :483-490.

[7]SONNEVELD MJ, ZOUTENDIJK R, JANSSEN HL.Hepatitis Bsurface antigen monitoring and management of chronic hepatitis B[J].J Viral Hepat, 2011, 18 (7) :449-457.

[8]TAN Z, LI M, KUANG X, et al.Clinical implications of hepatitis B surface antigen quantitation in the natural history of chronichepatitis B virus infection[J].J Clin Virol, 2014, 59 (4) :228-234.

[9] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[10]TSENG TC, LIU CJ, YANG HC, et al.Serum hepatitis B surface antigen levels help predict disease progression in patients with low hepatitis B virus loads[J].Hepatology, 2013, 57 (2) :441-450.

[11]TSENG T C, LIU C J, YANG H C, et al.High levels of hepatitis B surface antigen increase risk of hepatocellular carcinoma in patients with low HBV load[J].Gastroenterology, 2012, 142 (5) :1140-1149.

[12]ZHAO ZJ, WU JM, FU BB, et al.The correlation analysis between serum HBsAg and HBV DNA levels of entecavir in treatment of e antigen positive chronic hepatitis B patients[J].Chin J Gastroenterol Hepatol, 2015, 24 (5) :538-541. (in Chinese) 赵周静, 吴金明, 傅蓓蓓, 等.恩替卡韦初治HBe Ag阳性慢性乙型肝炎患者HBsAg与HBV DNA变化的相关性分析[J].胃肠病学和肝病学杂志, 2015, 24 (5) :538-541.

[13]European Association for the Study of the Liver.EASL clinical practice guidelines:Management of chronic hepatitis B virus infection[J].Hepatel, 2012, 57 (1) :167-185.

[14]JIN CT, GUO LW, LIANG WF.Research progress on non-invasive serum markers for liver fibrosis assessment in patients with chronic hepatitis B[J/CD].Chin J Exp Clin Infect Dis:E-lectronic Edition, 2018, 12 (1) :11-14. (in Chinese) 金彩婷, 郭利伟, 梁伟峰.慢性乙型病毒性肝炎肝纤维化无创性血清诊断指标研究进展[J/CD].中华实验和临床感染病杂志:电子版, 2018, 12 (1) :11-14.

[15]TRAN TT.Immune tolerant hepatitis B:A clinical dilemma[J].Gastroenterol Hepal, 2011, 7 (8) :511-516.

[16]JANG JW, YOO SH, KWON JH, et al.Serum hepatitis B surface antigen levels in the natural history of chronic hepatitis Binfection[J].Aliment Pharmacol Ther, 2011, 34 (11-12) :1337-1346.

[17]MARTINLT-PEIGNOUX M, LAPALUS M, ASSELAH T, et al.The role of HBsAg quantification for monitoring natural history and treatment outcome[J].Liver Int, 2013, 33 (Suppl 1) :125-132.

[18]LU W, ZHANG ZQ, SHEN F, et al.Serum HBsAg levels and HBV DNA loads in prediction of hepatic histological activity grading and fibrosis staging in patients with chronic hepatitis B[J].J Prac Hepatol, 2016, 19 (1) :20-25. (in Chinese) 陆伟, 张占卿, 沈芳, 等.血清HBSAG和HBV DNA定量水平预测慢性乙型肝炎患者肝组织炎症活动度和纤维化程度的评介[J].实用肝脏病杂志, 2016, 19 (1) :20-25.

[19]QIU HF, LI JH, YANG WJ, et al.Analysis of related factors of ALT persistently normal patients with chronic HBV infection[J].Chin J Nosocomiol, 2015, 25 (17) :3893-3895. (in Chinese) 邱惠芳, 李金花, 杨文君, 等.慢性乙型肝炎感染谷丙转氨酶持续正常患者肝脏病理相关因素分析[J].中华医院感染杂志, 2015, 25 (17) :3893-3895.

[20]LU FM, DOU XG, ZHANG WH, et al.Clinical significance of serunl HBV RNA measurement in chronic hepatitis B patients[J].J Clin Gepatol, 2018, 34 (5) :934-938. (in Chinese) 鲁凤民, 窦晓光, 张文宏, 等.慢性乙型肝炎患者血清HBV RNA检测的临床意义[J].临床肝胆病杂志, 2018, 34 (5) :934-938.

[21]GU JL, LIU SS, LI CF, et al.Value of highly sensitive serum virological markers in hepatitis B patients with a low viral load[J].JClin Hepatol, 2018, 34 (6) :1302-1307. (in Chinese) 谷九莲, 刘守胜, 李昌飞, 等.高灵敏度血清病毒学指标检测在低病毒载量乙型肝炎人群中的应用价值[J].临床肝胆病杂志, 2018, 34 (6) :1302-1307.

[22]XIAO BG.Pathological characteristics of liver tissues in chronic hepatitis B patients with different ages and serum HBV DNA loads[J].J Prac Hepatol, 2018, 21 (2) :277-278. (in Chinese) 肖贵宝.不同年龄和血清HBV DNA水平慢性乙型肝炎患者肝组织病理学变化[J].实用肝脏病杂志, 2018, 21 (2) :277-278.

[23]GAO HY, LIU L, LI CX, et al.Clinical characteristics and pathological analysis of liver tissue in patients with chronic hepatitis B virus infection[J].Hepatology, 2018, 23 (2) :136-139. (in Chinese) 高红艳, 刘娜, 李春霞, 等.慢性乙型肝炎病毒感染者免疫耐受期的临床特征与肝组织病理学分析[J].肝脏, 2018, 23 (2) :136-139.

[24]DING HB, LI YX, LAI JQ, et al.Correlation analysis of hepatic histopathology and portal vein diameter in patients with chronic hepatitis B[J].J Prac Hepatol, 2010, 13 (5) :369-370. (in Chinese) 丁红兵, 李奕鑫, 赖江琼, 等.慢性乙型肝炎患者肝组织病理学改变与门静脉内径的相关性分析[J].实用肝脏病杂志, 2010, 13 (5) :369-370.

[25]HUO XP, XIE QX, JIANG XP, et al.Pathological changes of liver tissues in 486 patients with chronic hepatitis B[J].J Prac Hepatol, 2015, 18 (4) :360-363. (in Chinese) 霍雪平, 谢琴秀, 江晓平, 等.486例慢性乙型肝炎患者肝组织病理学变化与肝功能指标的相关性研究[J].实用肝脏病杂志, 2015, 18 (4) :360-363.

施引文献

资源附件(0)

访问统计