CAJ | 학술논문

目的探讨慢性乙型肝炎（CHB）患者肝细胞HBV ccc DNA含量与血清HBV DNA、肝组织纤维化程度的相关性及在抗病毒治疗中的临床意义。方法对48例未接受抗病毒治疗CHB患者（A组）和6例经聚乙二醇化干扰素α-2a规律抗病毒治疗48周CHB患者（B组）进行肝组织活检以检测肝纤维化分期，并应用real time-PCR检测肝细胞HBV ccc DNA含量。分析A组患者肝细胞HBV ccc DNA与肝纤维化程度以及两组患者肝细胞HBV ccc DNA与血清HBV DNA相关性，分析B组患者HBV ccc DNA变化。结果肝细胞cccDNA及血清DNA水平均与肝组织纤维化程度呈负相关，但HBV ccc DNA相关性更强（r=-0.465，P=0.008）。肝细胞HBV ccc DNA与血清HBV DNA不存在相关性（r =0.057， P =0.418）。B组患者肝细胞HBV ccc DNA较对照组（自A组中选取性别、年龄及HBV DNA无差异患者共12例）显著下降，其中3例患者血清HBV DNA载量低于检测下限，但肝细胞仍可检出HBV ccc DNA。结论肝细胞HBV ccc DNA与肝纤维程度呈负相关，而血清HBV DNA水平不能反映肝内病毒复制的程度。CHB患者抗病毒治疗需要长期进行才可能完全清除肝细胞内HBV ccc DNA。
목적탐토만성을형간염（CHB）환자간세포HBV ccc DNA함량여혈청HBV DNA、간조직섬유화정도적상관성급재항병독치료중적림상의의。방법대48례미접수항병독치료CHB환자（A조）화6례경취을이순화간우소α-2a규률항병독치료48주CHB환자（B조）진행간조직활검이검측간섬유화분기，병응용real time-PCR검측간세포HBV ccc DNA함량。분석A조환자간세포HBV ccc DNA여간섬유화정도이급량조환자간세포HBV ccc DNA여혈청HBV DNA상관성，분석B조환자HBV ccc DNA변화。결과간세포cccDNA급혈청DNA수평균여간조직섬유화정도정부상관，단HBV ccc DNA상관성경강（r=-0.465，P=0.008）。간세포HBV ccc DNA여혈청HBV DNA불존재상관성（r =0.057， P =0.418）。B조환자간세포HBV ccc DNA교대조조（자A조중선취성별、년령급HBV DNA무차이환자공12례）현저하강，기중3례환자혈청HBV DNA재량저우검측하한，단간세포잉가검출HBV ccc DNA。결론간세포HBV ccc DNA여간섬유정도정부상관，이혈청HBV DNA수평불능반영간내병독복제적정도。CHB환자항병독치료수요장기진행재가능완전청제간세포내HBV ccc DNA。
Objective To explore the relationships among levels of HBV ccc DNA in hepatocytes, HBV DNA in serum and severity of liver ifbrosis in patients with chronic hepatitis B (CHB), and investigate its clinical signiifcance in antiviral therapy. Methods There were two groups of patients:group A were CHB patients who did not accept any antiviral therapy before (n=48);group B were CHB patients who received antiviral treatment with peginterferon alpha-2a for 48 weeks (n=6). All patients had done liver biopsies to determine the severity of liver ifbrosis and measured levels of HBV ccc DNA in hepatocytes by real time-PCR. The relationships between levels of HBV ccc DNA in hepatocytes and severity of liver ifbrosis in group A, and between levels of HBV ccc DNA in hepatocytes and HBV DNA in serum in both groups were analyzed. Changes of HBV ccc DNA level in hepatocytes were investigated in group B. Results Both levels of HBV ccc DNA in hepatocytes and HBV DNA in serum were negatively correlated with severity of liver ifbrosis, while HBV ccc DNA with more signiifcant relationship (r=-0.465, P=0.008). Levels of HBV ccc DNA in hepatocytes were not correlated with HBV DNA in serum (r=0.057, P=0.418). Levels of HBV ccc DNA and HBV DNA in patients who received antiviral therapy from group B were signiifcantly decreased compared to the control group (12 patients matched with sex, age and level of HBV DNA from group A). Total of 3 patients’ levels of HBV DNA in serum could not be detected, but HBV ccc DNA still existed in hepatocytes. Conclusions Levels of HBV ccc DNA in hepatocytes are negatively correlated with severity of liver ifbrosis, but levels of HBV DNA in serum could not relfect the replication of HBV in liver. HBV ccc DNA in hepatocytes could not be cleared completely until antiviral therapy for a long term in patients with CHB.