CAJ | 학술논문

目的：探讨乙型肝炎相关性肝衰竭患者血清HBV DNA低水平复制及HBV特异性抗体表达的相关因素及临床意义。方法收集2008年6月至2013年12月于天津市第二人民医院住院治疗的391例乙型肝炎相关性肝衰竭患者及394例慢性乙型肝炎患者的病历资料。比较乙型肝炎相关性肝衰竭与慢性乙型肝炎患者HBV DNA表达的不同及影响因素分析。根据HBV血清学标志物（HBV M）特异性表达的不同将肝衰竭患者分为特异性抗体阳性（指抗-HBs、抗-HBe和抗-HBc同时阳性）和特异性抗体阴性（无抗-HBs、抗-HBe和抗-HBc同时阳性）2组，分析2组患者HBV DNA水平的变化和生存情况。组间比较采用独立样本t检验或Mann-Whitney秩和检验，计数资料比较采用χ2检验。结果乙型肝炎相关性肝衰竭患者HBV DNA水平低于慢性乙型肝炎组，差异有统计学意义（Z＝-16．469，P＜0．05）；HBeAg阳性和阴性的肝衰竭患者HBV DNA水平均低于相应的慢性乙型肝炎患者，差异有统计学意义（Z分别为-11．665和-12．853，P＜0．05）。在391肝衰竭病例中，HBV特异性抗体阳性组29例（7．42％），死亡25例（86.21％）， HBV特异性抗体阴性组362例（92．58％），死亡157例（43．37％），2组病死率差异有统计学意义（P＜0.05）。特异性抗体阳性组患者HBV DNA水平明显低于特异性抗体阴性组，差异有统计学意义（Z＝-3．594，P＜0．05）。2组HBeAg阴性患者HBV DNA水平均低于HBeAg阳性患者，差异有统计学意义（Z分别为7．427和7．513，P＜0．05）。结论 HBV M表达形式及机体免疫状态的动态变化在乙型肝炎相关性肝衰竭的发生发展过程中起着一定作用，HBV DNA低水平复制系机体处于免疫清除期所致，而同时伴抗-HBs、抗-HBe、抗-HBc 3个抗体同时阳性则提示机体对HBV的超强免疫反应，致使病情恶化、发展迅速，病死率高。目的：探討乙型肝炎相關性肝衰竭患者血清HBV DNA低水平複製及HBV特異性抗體錶達的相關因素及臨床意義。方法收集2008年6月至2013年12月于天津市第二人民醫院住院治療的391例乙型肝炎相關性肝衰竭患者及394例慢性乙型肝炎患者的病歷資料。比較乙型肝炎相關性肝衰竭與慢性乙型肝炎患者HBV DNA錶達的不同及影響因素分析。根據HBV血清學標誌物（HBV M）特異性錶達的不同將肝衰竭患者分為特異性抗體暘性（指抗-HBs、抗-HBe和抗-HBc同時暘性）和特異性抗體陰性（無抗-HBs、抗-HBe和抗-HBc同時暘性）2組，分析2組患者HBV DNA水平的變化和生存情況。組間比較採用獨立樣本t檢驗或Mann-Whitney秩和檢驗，計數資料比較採用χ2檢驗。結果乙型肝炎相關性肝衰竭患者HBV DNA水平低于慢性乙型肝炎組，差異有統計學意義（Z＝-16．469，P＜0．05）；HBeAg暘性和陰性的肝衰竭患者HBV DNA水平均低于相應的慢性乙型肝炎患者，差異有統計學意義（Z分彆為-11．665和-12．853，P＜0．05）。在391肝衰竭病例中，HBV特異性抗體暘性組29例（7．42％），死亡25例（86.21％）， HBV特異性抗體陰性組362例（92．58％），死亡157例（43．37％），2組病死率差異有統計學意義（P＜0.05）。特異性抗體暘性組患者HBV DNA水平明顯低于特異性抗體陰性組，差異有統計學意義（Z＝-3．594，P＜0．05）。2組HBeAg陰性患者HBV DNA水平均低于HBeAg暘性患者，差異有統計學意義（Z分彆為7．427和7．513，P＜0．05）。結論 HBV M錶達形式及機體免疫狀態的動態變化在乙型肝炎相關性肝衰竭的髮生髮展過程中起著一定作用，HBV DNA低水平複製繫機體處于免疫清除期所緻，而同時伴抗-HBs、抗-HBe、抗-HBc 3箇抗體同時暘性則提示機體對HBV的超彊免疫反應，緻使病情噁化、髮展迅速，病死率高。
목적：탐토을형간염상관성간쇠갈환자혈청HBV DNA저수평복제급HBV특이성항체표체적상관인소급림상의의。방법수집2008년6월지2013년12월우천진시제이인민의원주원치료적391례을형간염상관성간쇠갈환자급394례만성을형간염환자적병력자료。비교을형간염상관성간쇠갈여만성을형간염환자HBV DNA표체적불동급영향인소분석。근거HBV혈청학표지물（HBV M）특이성표체적불동장간쇠갈환자분위특이성항체양성（지항-HBs、항-HBe화항-HBc동시양성）화특이성항체음성（무항-HBs、항-HBe화항-HBc동시양성）2조，분석2조환자HBV DNA수평적변화화생존정황。조간비교채용독립양본t검험혹Mann-Whitney질화검험，계수자료비교채용χ2검험。결과을형간염상관성간쇠갈환자HBV DNA수평저우만성을형간염조，차이유통계학의의（Z＝-16．469，P＜0．05）；HBeAg양성화음성적간쇠갈환자HBV DNA수평균저우상응적만성을형간염환자，차이유통계학의의（Z분별위-11．665화-12．853，P＜0．05）。재391간쇠갈병례중，HBV특이성항체양성조29례（7．42％），사망25례（86.21％）， HBV특이성항체음성조362례（92．58％），사망157례（43．37％），2조병사솔차이유통계학의의（P＜0.05）。특이성항체양성조환자HBV DNA수평명현저우특이성항체음성조，차이유통계학의의（Z＝-3．594，P＜0．05）。2조HBeAg음성환자HBV DNA수평균저우HBeAg양성환자，차이유통계학의의（Z분별위7．427화7．513，P＜0．05）。결론 HBV M표체형식급궤체면역상태적동태변화재을형간염상관성간쇠갈적발생발전과정중기착일정작용，HBV DNA저수평복제계궤체처우면역청제기소치，이동시반항-HBs、항-HBe、항-HBc 3개항체동시양성칙제시궤체대HBV적초강면역반응，치사병정악화、발전신속，병사솔고。
Objective To investigate the influential factors and clinical significance of low-level hepatitis B virus (HBV)DNA replication and specific antibody expression in patients with HBV-related liver failure.Methods A retrospective analysis was performed on the medi-cal records of 39 1 patients with HBV-related liver failure and 394 patients with chronic hepatitis B (CHB)hospitalized in the Tianjin Sec-ond People′s Hospital from June 2008 to December 2013.The HBV DNA level was compared between patients with HBV-related liver fail-ure and those with CHB,and the influential factors were analyzed.According to the expression of HBV serum markers (HBV-Ms),pa-tients with liver failure were divided into specific antibody-positive group (positive for anti-HBs,anti-HBe or anti-HBc)and specific antibody-negative group (negative for anti-HBs,anti-HBe or anti-HBc).The changes in HBV DNA level and survival were compared between the two groups.Between-group comparison was made by independent-samples t test or Mann-Whitney rank sum test,and com-parison of enumeration data was made by chi-square test.Results The patients with HBV-related liver failure had a significantly lower HBV DNA level than the CHB patients (Z=-16.469,P<0.05).The levels of HBV DNA in HBeAg-positive and -negative patients with liver failure were significantly lower than those in patients with CHB (Z1 =-11.665,P<0.05;Z2 =-12.853,P<0.05).Of the 391 patients with HBV -related liver failure,29 (7.42%)were specific antibody -positive,and 25 (86.21%)of them died;362 (92.58%)were specific antibody-negative,and 157 (43.37%)of them died.There was a significant difference in mortality between the specific antibody-positive and specific antibody-negative groups (P<0.05).The specific antibody-positive group had a significantly lower HBV DNA level than the specific antibody-negative group (Z=-3.594,P<0.05).For either group,the HBV DNA level was sig-nificantly lower in HBeAg-negative patients than in HBeAg-positive patients (Z=7.427 or 7.513,P<0.05).Conclusion HBV Mex-pression and the body′s immune status play a role in the progression of HBV-related liver failure.HBV DNA replication is at a low level in the immune clearance phase.Being positive for anti-HBs,anti-HBe,and anti-HBc suggest a super immune response to HBV,leading to rapid progression of disease and high mortality.