CAJ | 학술논문

目的了解HBV DNA水平自发性下降在慢性乙型肝炎(CHB)患者中的发生率、分布特征及其影响因素.方法应用临床流行病学调查方法研究315例CHB或肝硬化(LC)患者HBVDNA自发性下降的发生率、人口学特点及诊断分布情况,并采用Logistic回归分析HBV DNA自发性下降的影响因素.结果在12周内发生HBV DNA自发性下降的患者为171例,占54.3%,其中,HBV DNA降至3 lg拷贝/mL以下的患者为61例.占19.4%.分层研究显示青年组与少年组患者HBV DNA自发性下降率分别为58.6%(116/198例)和25.0%(2/8例),前者高于后者(X2=2.956,P=0.048);病情重的比病情轻的患者更易发生HBV DNA自发性下降,两两比较,有差异组的均X2＞3.84,P＜0.05,其中慢性重型肝炎的下降率最高,达78.7%(48/61例).重叠HEV感染与单纯HBV感染患者HBV DNA自发性下降率分别为75.0%(21/28例)和51.8%(146/282例),前者高于后者(X2=5.530,P=0.019).ALT＞400 U/L与ALT≤400 U/L的患者HBV DNA自发性下降率分别为61.8%(102/165例)和46.0%(69/150例),前者高于后者(X2=7.922,P=0.005);TBil＞200 μmol/L与TBil≤200 μmol/L的患者HBV DNA自发性下降率分别为68.7%(79/115例)和46.0%(92/200例),前者高于后者(X2=15.155,P:0.000).多因素Logistic回归分析显示,慢性重型肝炎、ALT＞400 U/L、TBil＞200 μmol/L 是CHB或LC患者发牛HBV DNA自发性下降的影响因素(均OR＞1,P＜0.05).结论 HBV DNA水平自发性下降足CHB或LC患者自然病程进展(免疫清除期)中的常见现象.患者病情严重、ALT高、TBil高,则易发生HBV DNA自发性下降.
목적 료해HBV DNA수평자발성하강재만성을형간염(CHB)환자중적발생솔、분포특정급기영향인소.방법 응용림상류행병학조사방법연구315례CHB혹간경화(LC)환자HBVDNA자발성하강적발생솔、인구학특점급진단분포정황,병채용Logistic회귀분석HBV DNA자발성하강적영향인소.결과 재12주내발생HBV DNA자발성하강적환자위171례,점54.3%,기중,HBV DNA강지3 lg고패/mL이하적환자위61례.점19.4%.분층연구현시청년조여소년조환자HBV DNA자발성하강솔분별위58.6%(116/198례)화25.0%(2/8례),전자고우후자(X2=2.956,P=0.048);병정중적비병정경적환자경역발생HBV DNA자발성하강,량량비교,유차이조적균X2＞3.84,P＜0.05,기중만성중형간염적하강솔최고,체78.7%(48/61례).중첩HEV감염여단순HBV감염환자HBV DNA자발성하강솔분별위75.0%(21/28례)화51.8%(146/282례),전자고우후자(X2=5.530,P=0.019).ALT＞400 U/L여ALT≤400 U/L적환자HBV DNA자발성하강솔분별위61.8%(102/165례)화46.0%(69/150례),전자고우후자(X2=7.922,P=0.005);TBil＞200 μmol/L여TBil≤200 μmol/L적환자HBV DNA자발성하강솔분별위68.7%(79/115례)화46.0%(92/200례),전자고우후자(X2=15.155,P:0.000).다인소Logistic회귀분석현시,만성중형간염、ALT＞400 U/L、TBil＞200 μmol/L 시CHB혹LC환자발우HBV DNA자발성하강적영향인소(균OR＞1,P＜0.05).결론 HBV DNA수평자발성하강족CHB혹LC환자자연병정진전(면역청제기)중적상견현상.환자병정엄중、ALT고、TBil고,칙역발생HBV DNA자발성하강.
Objective To study the incidence and distribution features of spontaneous decrease of hepatitis B virus (HBV) DNA level and its correlative factors in chronic hepatitis B (CHB) patients.Methods The incidence,demographic features and distribution of different clinical types of spontaneous decrease of HBV DNA were investigated with clinical epidemiological study in 315 CHB or live cirrhosis (LC) patients.The correlative factors of spontaneous decrease of HBV DNA were analyzed by Logistic regression methods.Results Among the 315 patients,171 patients (54.3%) underwent spontaneous decrease of HBV DNA within 12 weeks,of which 61 patients (19.4%) had undeteetable HBV DNA (＜3 lg copy/mL).The stratified study showed that the incidence of spontaneous decrease of HBV DNA in young patients was 58.6% (116/198 cases),which was higher than that (25.0%,2/8 cases) in juvenile patients (X2 = 2.956,P=0.048).The incidence of decrease in relatively more severe patients was higher than that in relatively less severe patients (all X2 in significant groups＞3.84,all P＜0.05),and the highest incidence was 78.7% (48/61 cases) in patients with chronic severe hepatitis B.The incidence of spontaneous decrease of HBV DNA in hepatitis E virus (HEV)/HBV coinfected patients was 75.0% (21/28 cases),which was higher than that (51.8%,146/282 cases) in single HBV-infected patients (X2 =5.530,P=0.019).The incidence of spontaneous decrease of HBV DNA in patients with alanire aminotransferase (ALT)＞400 U/L was 61.8%(102/165 cases),which was higher than that (46.0%,69/150 cases) in patients with ALT≤400 U/L (X2 =7.922,P=0.005).The incidence of spontaneous decrease of HBV DNA in patients with TBil＞200 μmol/L was 68.7% (79/115 cases),which was higher than that (46.0%,92/200 cases) in patients with TBil≤200 μmol/L (X2 = 15.155,P=0.000).The multivariate Logistic analysis demonstrated that chronic severe hepatitis B,ALT＞ 400 U/L and TBil＞ 200 μmol/L were the correlative factors with spontaneous decrease of HBV DNA in CHB or LC patients (all OR＞1,all P＜0.05).Conclusions The spontaneous decrease of HBV DNA level is a common phenomenon during the natural course (immune clearance phase) of CHB or LC patients.Patients with sever conditions,elevated levels of ALT and total bilirubin (TBil) tend to develop spontaneous decrease of HBV DNA.