CAJ | 학술논문

目的观察分析成人急性乙型肝炎(AHB)病原学特点,探讨急性HBV感染肝损伤及病毒清除的机制.方法以120例成人AHB患者为研究对象.采取病区及门诊随访方法,收集患者流行病学资料和住院期间及出院后历次复诊时的系列血清标本,ELISA法检测血清HBV标志物,实时荧光定量PCR法检测HBV DNA和HBV基因型,动态观察AHB病原学变化规律.计数资料采用非参数秩和检验,组间均数比较采用t检验,两个样本率的比较采用Pearsonχ2检验.结果就诊时48.33%的患者HBV DNA阳性,平均为9.84×104拷贝/mL,平均12.5 d降到检测限以下.HBVDNA阳性组血ALT中位数为1600 U/L,阴性组为1490 U/L(z=0.678,P=0.498);HBV DNA≤1×104拷贝/mL组血ALT为(2058±123)U/L,>1×104拷贝/mL组为(1393±139)U/L,差异有统计学意义(t=2.17,P-0.049).40份HBV DNA阳性标本中,HBV B基因型占52.5%,C基因型占42.5%,B、C混合型占5.0%.初诊时血清HBV标志物呈现8种模式,以HBsAg、HBeAg、抗-HBc、抗-HBc IgM阳性和HBsAg、抗-HBe、抗-HBc、抗-HBe IgM阳性2种模式最多见,分别占38.3%和30.0%.前瞻性动态监测28例AHB患者HBV标志物,HBsAg阴转率为100.0%,平均阴转时间中位数为3周;观察52周抗-HBs累计阳转率为85.7%;HBeAg阴转率为100.0%,其中53.6%的患者就诊时血清HBeAg已转阴,其余患者于发病4周内阴转,在52周的观察期内抗-HBe阳转率为82.1%;血清抗-HBc(总抗体)始终为阳性,39.3%患者抗-HBc IgM在观测期阴转.结论快速HBV的清除和病毒标志物的血清转换,构成了AHB与慢性乙型肝炎的显著差异.
목적 관찰분석성인급성을형간염(AHB)병원학특점,탐토급성HBV감염간손상급병독청제적궤제.방법 이120례성인AHB환자위연구대상.채취병구급문진수방방법,수집환자류행병학자료화주원기간급출원후력차복진시적계렬혈청표본,ELISA법검측혈청HBV표지물,실시형광정량PCR법검측HBV DNA화HBV기인형,동태관찰AHB병원학변화규률.계수자료채용비삼수질화검험,조간균수비교채용t검험,량개양본솔적비교채용Pearsonχ2검험.결과 취진시48.33%적환자HBV DNA양성,평균위9.84×104고패/mL,평균12.5 d강도검측한이하.HBVDNA양성조혈ALT중위수위1600 U/L,음성조위1490 U/L(z=0.678,P=0.498);HBV DNA≤1×104고패/mL조혈ALT위(2058±123)U/L,>1×104고패/mL조위(1393±139)U/L,차이유통계학의의(t=2.17,P-0.049).40빈HBV DNA양성표본중,HBV B기인형점52.5%,C기인형점42.5%,B、C혼합형점5.0%.초진시혈청HBV표지물정현8충모식,이HBsAg、HBeAg、항-HBc、항-HBc IgM양성화HBsAg、항-HBe、항-HBc、항-HBe IgM양성2충모식최다견,분별점38.3%화30.0%.전첨성동태감측28례AHB환자HBV표지물,HBsAg음전솔위100.0%,평균음전시간중위수위3주;관찰52주항-HBs루계양전솔위85.7%;HBeAg음전솔위100.0%,기중53.6%적환자취진시혈청HBeAg이전음,기여환자우발병4주내음전,재52주적관찰기내항-HBe양전솔위82.1%;혈청항-HBc(총항체)시종위양성,39.3%환자항-HBc IgM재관측기음전.결론 쾌속HBV적청제화병독표지물적혈청전환,구성료AHB여만성을형간염적현저차이.
Objective To understand the etiology of acute hepatitis B (AHB) in adults and investigate the mechanisms of hepatic injury and viral clearance in AHB. Methods One hundred and twenty adult AHB patients were enrolled. Epidemiological and clinical data were collected from the case history records or face-to-face inquiry, and serum samples were collected during hospitalization and follow-up. To observe dynamic patterns of AHB etiology, the markers of hepatitis B virus (HBV) were detected by enzyme-linked immunosorbent assay (ELISA); the level of HBV DNA and HBV genotype were determined by real-time polymerase chain reaction (PCR). Enumeration data were analyzed by non-parametric rank sum test. Comparison between groups was done by t test and that between rates of samples was done by Pearson χ2 test. Results Serum HBV DNA was positive in 48.33% of patients at the time of diagnosis with mean level of 9.84×04 copy/mL, and became undetectable after 12.5 days on average. The median levels of serum alanine aminotransferase (ALT) were 1600 U/L and 1490 U/L in HBV DNA positive and negative groups, respectively (z=-0. 678, P=0. 498). However, the mean levels of serum ALT were (2058±123) U/L and (1393±139) U/L in groups of HBV DNA<1×104 copy/mL and>1×104 copy/mL, respectively, which was significantly different (t=-2.17, P=0. 049). Genotype B accounted for 52.5%, genotype C 42.5 and genotype B and C mixed type 5.0% in 58 patients with HBV DNA positive. Eight patterns of serum HBV markers were presented at first visiting. HBsAg(+), HBeAg(+), anti-HBc(+), anti-HBc IgM(+) and HBsAg(+), anti-HBe(+), anti-HBc(+), anti-HBc IgM(+) were the most common patterns, which accounted for 38.3% and 30.0%, respectively. The dynamic patterns of serum HBV markers of 28 AFIB patients were prospectively followed up. The rate of serum FIBsAg loss was 100. 0% and the median time of negative-conversion was 3 weeks. The cumulative positive rate of anti-HBs was 85.7% after 52 weeks of follow-up. The rate of serum HBeAg loss was 100.0%. HBeAg was negative in 53.6% of patients at first visiting and the rest of patients achieved negative within 4 weeks after onset. The positive rate of anti-HBe was 82.1% during 52 weeks of follow-up. Total anti-HBc (including IgG and IgM) was keeping positive in all patients within 52 weeks, and the negative rate of anti-HBc IgM was 39. 3% after followed up for 52 weeks. Conclusions Rapid HBV clearance andserum HBV marker conversion are significantly different between AHB and chronic hepatitis B.