CAJ | 학술논문

目的明确病毒因素与成人急性乙型肝炎(AHB)病情恢复的关系.方法 2003年至2007年入住上海长海医院的97例成人AHB患者纳入本研究,随访24周.收集患者肝功能、病毒学指标和相关流行病学资料,同时应用直接基因测序法对54例AHB患者血清HBV S区进行基因分型.组间均数差异应用t检验,频率差异用X2检验.结果 97例患者的临床表现均比较缓和,83例在病程中发生自发的HBeAg和HBsAg血清学转换.14例患者出现慢性化趋势,其HBVDNA较无慢性化趋势者高[(6.17±1.04)lg拷贝/mL比(3.86士1.85)lg拷贝/mL,t=5.95,P<0.01],其中6例接受抗病毒治疗后发生HBsAg血清学转换,8例未接受抗病毒治疗的患者发展为持续HBV携带.AHB的主要病毒基因型为B型和C型,两种病毒基因型感染者间流行病学和生化指标比较,差异无统计学意义.基线高病毒载量是发展为慢性感染的高危因素.结论 2003年至2007年长海医院收治成人AHB主要病毒基因型为B和C型,病毒基因型和临床转归无明显相关性.基线高病毒载量同临床转归具有明显相关性,适时抗病毒治疗可减少HBV感染持续率.
목적 명학병독인소여성인급성을형간염(AHB)병정회복적관계.방법 2003년지2007년입주상해장해의원적97례성인AHB환자납입본연구,수방24주.수집환자간공능、병독학지표화상관류행병학자료,동시응용직접기인측서법대54례AHB환자혈청HBV S구진행기인분형.조간균수차이응용t검험,빈솔차이용X2검험.결과 97례환자적림상표현균비교완화,83례재병정중발생자발적HBeAg화HBsAg혈청학전환.14례환자출현만성화추세,기HBVDNA교무만성화추세자고[(6.17±1.04)lg고패/mL비(3.86사1.85)lg고패/mL,t=5.95,P<0.01],기중6례접수항병독치료후발생HBsAg혈청학전환,8례미접수항병독치료적환자발전위지속HBV휴대.AHB적주요병독기인형위B형화C형,량충병독기인형감염자간류행병학화생화지표비교,차이무통계학의의.기선고병독재량시발전위만성감염적고위인소.결론 2003년지2007년장해의원수치성인AHB주요병독기인형위B화C형,병독기인형화림상전귀무명현상관성.기선고병독재량동림상전귀구유명현상관성,괄시항병독치료가감소HBV감염지속솔.
Objective To identify the relationship between viral factors and disease progression in patients with acute hepatitis B virus (HBV) infection. Methods Ninety-seven adult patients with acute HBV infection in Shanghai Changhai Hospital were enrolled in this study and followed up for 24 weeks. Epidemiological, biochemical and virological parameters of all patients were collected. HBV S region from sera of 54 patients with acute HBV infection were genotyped using direct nucleotide sequencing. Differences of means between groups were compared by t-test, and frequency between groups was compared by X test. Results The clinical manifestations of all patients were mild and the 83 patients spontaneously developed HBeAg and HBsAg seroconversion. However, 14 patients had a tendency of chronicity, with HBV DNA level higher than patients without chronicity tendency [(6. 17 ±1. 04) 1g copy/mL vs (3. 86±1. 85)1g copy/mL;t = 5. 95, P<0. 01]. Among the 14 patients, 6 obtained HBsAg seroconversion after antiviral therapy and the other 8 developed to be sustained HBV carrier who had not received antiviral therapy. The main genotypes of acute HBV infection were genotypes B and C. There were no statistically significant differences of epidemiological factors and biochemical results between patients with the two genotypes of HBV infection. High viral load at baseline was the risk factor of chronicity tendency. Conclusions The main genotypes of acute HBVinfection in Changhai Hospital in the year from 2003 to 2007 are genotypes B and C. There is no significant relationship between genotype and clinical outcome. While high viral load at baseline is significantly associated with chronicity tendency. Proper antiviral therapy can decrease sustained HBV infection rate.