CAJ | 학술논문

目的探讨慢性乙型肝炎(CHB)抗病毒疗效与达到停药标准时外周血单个核细胞(PBMC)内HBV DNA水平的关系.方法入选90例经抗病毒治疗达到停药标准的CHB患者,其中应用IFN 44例,应用核苷类药物46例.所有患者均于停药时检测PBMC内HBV DNA,比较阴性组和阳性组治疗前血清HBV DNA水平与达到停药标准时PBMC内HBV DNA的关系,观察停药时PBMC内HBV DNA水平与复发的关系.计量资料采用t检验,计数资料采用X2检验.结果 90例CHB患者停药时,PBMC内HBV DNA阴性组67例,阳性组23例.CHB患者血清HBV DNA阳转率在PBMC内HBV DNA阴性组为13.4%(9/67例),显著低于阳性组的73.9%(17/23例),差异有统计学意义(X2=30.4873,P<0.01).PBMC内HBV DNA阴性组与阳性组在肝病复发ALT升高幅度(t=0.8729,P=0.3913)、停药后复发时间(t=1.9222,P=0.0665)均差异无统计学意义,而在血清HBV DNA反弹幅度则差异有统计学意义(t=2.7493,P=0.0112).5例患者获得HBsAg血清学转换,且均未检测到PBMC内HBV DNA,随访6～12个月无一例复发.PBMC内HBV DNA阳性组治疗前血清HBV DNA水平为(7.2±1.1)lg拷贝/mL,显著高于阴性组的(5.2±2.1)lg拷贝/mL(t=4.3557,P<0.01).结论经抗病毒治疗达到停药标准的CHB患者,其停药时的PBMC内HBV DNA水平可能是预测抗病毒疗效持久性的重要因素之一.
목적 탐토만성을형간염(CHB)항병독료효여체도정약표준시외주혈단개핵세포(PBMC)내HBV DNA수평적관계.방법 입선90례경항병독치료체도정약표준적CHB환자,기중응용IFN 44례,응용핵감류약물46례.소유환자균우정약시검측PBMC내HBV DNA,비교음성조화양성조치료전혈청HBV DNA수평여체도정약표준시PBMC내HBV DNA적관계,관찰정약시PBMC내HBV DNA수평여복발적관계.계량자료채용t검험,계수자료채용X2검험.결과 90례CHB환자정약시,PBMC내HBV DNA음성조67례,양성조23례.CHB환자혈청HBV DNA양전솔재PBMC내HBV DNA음성조위13.4%(9/67례),현저저우양성조적73.9%(17/23례),차이유통계학의의(X2=30.4873,P<0.01).PBMC내HBV DNA음성조여양성조재간병복발ALT승고폭도(t=0.8729,P=0.3913)、정약후복발시간(t=1.9222,P=0.0665)균차이무통계학의의,이재혈청HBV DNA반탄폭도칙차이유통계학의의(t=2.7493,P=0.0112).5례환자획득HBsAg혈청학전환,차균미검측도PBMC내HBV DNA,수방6～12개월무일례복발.PBMC내HBV DNA양성조치료전혈청HBV DNA수평위(7.2±1.1)lg고패/mL,현저고우음성조적(5.2±2.1)lg고패/mL(t=4.3557,P<0.01).결론 경항병독치료체도정약표준적CHB환자,기정약시적PBMC내HBV DNA수평가능시예측항병독료효지구성적중요인소지일.
Objective To explore the relationship between the antiviral effect and peripheral blood mononuclear cell (PBMC) hepatitis B virus (HBV) DNA when the patients reach the standard of withdrawal of antiviral therapy in chronic hepatitis B (CHB).Methods Ninety CHB patients treated with interferon(n=44) or nucleot (s) ide(n=46) who reached the standard of withdrawal of antiviral therapy were recruited.HBV DNA levels in PBMCs were tested at the end of treatment,and its relationship with serum HBV DNA level before treatment in PBMC HBV DNA positive group and negative group were compared.The correlation between HBV DNA in PBMCs at the end of treatment and relapse were explored.Measurement data were analyzed by student t test and enumeration data were analyzed by X2 test.Results Among 90 patients,67(74.4%) were PBMC HBV DNA negative at the end of treatment,and 23(25.6%) were positive.The serum HBV DNA positive conversion rate in PBMC HBV DNA negative patients was 13.4%,which were significantly lower than that in positive group (73.9%) (X2=30. 4873, P<0.01 ). There were no significant differences of alanine aminotransferase (ALT) levels when hepatitis flare (t=0. 8729, P=0. 3913) and relapse time (t=1. 9222, P=0. 0665) between PBMC HBV DNA negative group and positive group after withdrawal of therapy, while the serum HBV DNA rebound was greater in positive group than that in negative group (t=2. 7493, P=0. 0112). There were five patients who achieved hepatitis B surface antigen (HBsAg) seroconversion, whose PBMC HBV DNA were all undetectable, and none relapsed during follow-up for 6-12 months. The pretreatment HBV DNA as level in PBMC HBV DNA positive was (7.2±1.1) lg copy/mL, which was much higher than that in negative group[(5.2±2.1) lg copy/mL] (t=4. 3557, P<0.01). Conclusions In patients who reach the standard of drug withdrawal,PBMC HBV DNA at the end of treatment is an important predictor for durability of antiviral therapy in CHB.