CAJ | 학술논문

目的探讨不同HBeAg状态慢加急性肝衰竭(ACLF)患者临终前HBV DNA载量的动态变化及其临床意义.方法回顾性分析107例ACLF患者临终前29～56d、15 ～ 28d和0～ 14d血清HBeAg、抗-HBe和HBV DNA载量,比较不同HBeAg状态和时间段患者的HBV DNA载量差异.两组间均数比较采用t检验;多组均数之间比较采用ONE-WAY ANOVA分析. 结果 HBeAg(+)患者37例,上述3个时间段HBV DNA载量依次为(6.11±1.63)、(5.61±1.50)、(5.29±1.96) log10拷贝/ml; 70例抗-HBe(+)患者顺次为(4.63±1.82)、(5.81±1.78)、(4.93±1.73)log10拷贝/ml.HBeAg (+)组与抗-HBe(+)组相同时间段比较,HBV DNA载量在临终前29 ～ 56 d差异有统计学意义(t=2.606,P=0.015,P＜0.05),但临终前15～28d和0～ 14d的差异均无统计学意义(P＞0.05).同组内三个时段HBV DNA载量的两两比较,HBeAg(+)组差异均无统计学意义(P＞0.05);抗-HBe(+)组在临终前29 ～ 56d与15 ～ 28d或0～ 14d的差异也无统计学意义(P＞0.05),但临终前15 ～ 28d和0～ 14d的差异有统计学意义(P=0.026,P＜0.05).结论在致死性ACLF的启动,HBeAg(+)患者HBV DNA水平高于抗-HBe(+)者.随着肝衰竭恶化,HBeAg(+)患者HBV DNA载量维持一定水平,而抗-HBe(+)患者HBV DNA载量在终末期呈下降状态.
목적 탐토불동HBeAg상태만가급성간쇠갈(ACLF)환자림종전HBV DNA재량적동태변화급기림상의의.방법 회고성분석107례ACLF환자림종전29～56d、15 ～ 28d화0～ 14d혈청HBeAg、항-HBe화HBV DNA재량,비교불동HBeAg상태화시간단환자적HBV DNA재량차이.량조간균수비교채용t검험;다조균수지간비교채용ONE-WAY ANOVA분석. 결과 HBeAg(+)환자37례,상술3개시간단HBV DNA재량의차위(6.11±1.63)、(5.61±1.50)、(5.29±1.96) log10고패/ml; 70례항-HBe(+)환자순차위(4.63±1.82)、(5.81±1.78)、(4.93±1.73)log10고패/ml.HBeAg (+)조여항-HBe(+)조상동시간단비교,HBV DNA재량재림종전29 ～ 56 d차이유통계학의의(t=2.606,P=0.015,P＜0.05),단림종전15～28d화0～ 14d적차이균무통계학의의(P＞0.05).동조내삼개시단HBV DNA재량적량량비교,HBeAg(+)조차이균무통계학의의(P＞0.05);항-HBe(+)조재림종전29 ～ 56d여15 ～ 28d혹0～ 14d적차이야무통계학의의(P＞0.05),단림종전15 ～ 28d화0～ 14d적차이유통계학의의(P=0.026,P＜0.05).결론 재치사성ACLF적계동,HBeAg(+)환자HBV DNA수평고우항-HBe(+)자.수착간쇠갈악화,HBeAg(+)환자HBV DNA재량유지일정수평,이항-HBe(+)환자HBV DNA재량재종말기정하강상태.
Objective To investigate the dynamics and clinical significance of serum hepatitis B virus (HBV) DNA levels during the terminal phase of acute-on-chronic liver failure (ACLF) with different hepatitis B e antigen (HBeAg) status.Methods One-hundred-and-seven patients with terminal ACLF were tested for HBeAg status by electrochemiluminescence immunoassay and serum HBV DNA levels by real-time PCR at three chronological time ranges,representing increasing severity of disease phases prior to death (day 0):29-56 d,15-28 d,and 0-14 d.Results In the 37 HBeAg(+) patients,HBV DNA ievels at above-mentioned phases were 6.10± 1.63,5.61 ± 1.50,and 5.29± 1.96 log10 copies/mL.In the 70 anti-HBe(+) patients,HBV DNA levels were 4.63 ± 1.82,5,81± 1.78,and 4.93 ±1.73 log10 copies/mL.Phase to phase comparisons revealed that the HBV DNA level in the HBeAg(+) group was significantly higher than that in the anti-HBe(+)group at 29-56 d (P＜0.05),and that 15-28 d and 0-14 d were not significantly different (P＞0.05).Intragroup comparisons of phases revealed no significant differences in the HBeAg(+) group (P＞0.05),but a significant difference between 15-28 d and 0-14 d (P＜0.05) for the anti-HBe(+) group.Conclusion Serum levels of HBV DNA in patients with HBeAg positivity are higher than those in patients with anti-HBe positivity as the disease phase of ACLF nears fatality.Following the deterioration to liver failure,the HBV DNA load in HBeAg(+) patients remains stable while that in anti-HBe(+) patients decreases.