乙型肝炎相关性肝衰竭患者HBV DNA低水平复制及特异性抗体表达的临床意义

田方圆; 单静; 唐宽银; 曹武奎

doi:10.3969/j.issn.1001-5256.2014.06.012

乙型肝炎相关性肝衰竭患者HBV DNA低水平复制及特异性抗体表达的临床意义

DOI: 10.3969/j.issn.1001-5256.2014.06.012

1. 天津医科大学研究生院
2. 天津市第二人民医院天津市肝病医学研究所

基金项目:

国家“十二五”科技重大专项(2012ZX10005005)；

详细信息

中图分类号: R512.62;R575.3
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出版历程
- 收稿日期: 2014-01-15
- 出版日期: 2014-06-20

Clinical significance of low- level HBV DNA replication and specific antibody expression in patients with HBV- related liver failure

Graduate School of Tianjin Medical University

Research funding:

摘要

摘要: 目的探讨乙型肝炎相关性肝衰竭患者血清HBV DNA低水平复制及HBV特异性抗体表达的相关因素及临床意义。方法收集2008年6月至2013年12月于天津市第二人民医院住院治疗的391例乙型肝炎相关性肝衰竭患者及394例慢性乙型肝炎患者的病历资料。比较乙型肝炎相关性肝衰竭与慢性乙型肝炎患者HBV DNA表达的不同及影响因素分析。根据HBV血清学标志物（HBV M）特异性表达的不同将肝衰竭患者分为特异性抗体阳性（指抗-HBs、抗-HBe和抗-HBc同时阳性）和特异性抗体阴性（无抗-HBs、抗-HBe和抗-HBc同时阳性）2组,分析2组患者HBV DNA水平的变化和生存情况。组间比较采用独立样本t检验或MannWhitney秩和检验,计数资料比较采用χ2检验。结果乙型肝炎相关性肝衰竭患者HBV DNA水平低于慢性乙型肝炎组,差异有统计学意义（Z=-16.469,P<0.05）;HBeAg阳性和阴性的肝衰竭患者HBV DNA水平均低于相应的慢性乙型肝炎患者,差异有统计学意义（Z分别为-11.665和-12.853,P<0.05）。在391肝衰竭病例中,HBV特异性抗体阳性组29例（7...
- 肝功能衰竭 /
- 肝炎,乙型,慢性 /
- 乙型肝炎病毒 /
- 乙型肝炎抗体
Abstract: Objective To investigate the influential factors and clinical significance of low- level hepatitis B virus ( HBV) DNA replication and specific antibody expression in patients with HBV- related liver failure. Methods A retrospective analysis was performed on the medical records of 391 patients with HBV- related liver failure and 394 patients with chronic hepatitis B ( CHB) hospitalized in the Tianjin Second People's Hospital from June 2008 to December 2013. The HBV DNA level was compared between patients with HBV- related liver failure and those with CHB, and the influential factors were analyzed. According to the expression of HBV serum markers ( HBV- Ms) , patients with liver failure were divided into specific antibody- positive group ( positive for anti- HBs, anti- HBe or anti- HBc) and specific antibody- negative group ( negative for anti- HBs, anti- HBe or anti- HBc) . The changes in HBV DNA level and survival were compared between the two groups. Between- group comparison was made by independent- samples t test or Mann- Whitney rank sum test, and comparison of enumeration data was made by chi- square test. Results The patients with HBV- related liver failure had a significantly lower HBV DNA level than the CHB patients ( Z =- 16. 469, P < 0. 05) . The levels of HBV DNA in HBeAg- positive and- negative patients with liver failure were significantly lower than those in patients with CHB ( Z1=- 11. 665, P < 0. 05; Z2=- 12. 853, P < 0. 05) . Of the391 patients with HBV- related liver failure, 29 ( 7. 42%) were specific antibody- positive, and 25 ( 86. 21%) of them died; 362 ( 92. 58%) were specific antibody-negative, and 157 ( 43.37%) of them died. There was a significant difference in mortality between the specific antibody- positive and specific antibody- negative groups ( P < 0. 05) . The specific antibody- positive group had a significantly lower HBV DNA level than the specific antibody- negative group ( Z =- 3. 594, P < 0. 05) . For either group, the HBV DNA level was significantly lower in HBeAg- negative patients than in HBeAg- positive patients ( Z = 7. 427 or 7. 513, P < 0. 05) . Conclusion HBV M expression and the body's immune status play a role in the progression of HBV- related liver failure. HBV DNA replication is at a low level in the immune clearance phase. Being positive for anti- HBs, anti- HBe, and anti- HBc suggest a super immune response to HBV, leading to rapid progression of disease and high mortality.
- liver failure /
- hepatitis B, chronic /
- hepatitis B virus /
- hepatitis B antibodies

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参考文献(15)

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