中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2014年
3期
185-189
,共5页
丁玉平%邹志强%徐学彩%赵增红%贾伟%方雨晴%李媛媛%郭砚梅%王贵强
丁玉平%鄒誌彊%徐學綵%趙增紅%賈偉%方雨晴%李媛媛%郭硯梅%王貴彊
정옥평%추지강%서학채%조증홍%가위%방우청%리원원%곽연매%왕귀강
肝炎,乙型,慢性%肝炎核心抗原,乙型%病理学
肝炎,乙型,慢性%肝炎覈心抗原,乙型%病理學
간염,을형,만성%간염핵심항원,을형%병이학
Hepatitis B,chronic%Hepatitis B core antigens%Pathology
目的 探讨慢性乙型肝炎患者肝组织中HBcAg的表达类型与HBV DNA复制及炎症损伤的关系,分析HBeAg阳性或阴性慢性乙型肝炎患者的临床病理学特点与HBcAg的表达差异.方法 回顾性分析63例通过肝穿刺病理学诊断的慢性乙型肝炎患者资料,肝组织病理学及HBcAg表达与外周血淋巴细胞数量、单核细胞数量、HBV DNA载量的关系.连续计量资料符合正态分布、且方差齐者,采用独立样本T检验;非正态分布采用非参数检验(Mann-Whitney U检验);计数资料通过x2或Fishers精确概率检验;连续变量之间采用Pearson相关分析,等级变量之间比较采用Spearman等级相关分析. 结果 63例肝穿刺患者中,HBeAg阳性慢性乙型肝炎患者48例,HBV DNA中位滴度为5.4×106拷贝/ml,HBeAg阴性慢性乙型肝炎患者15例,HBV DNA中位滴度为5.4×104拷贝/ml,两组比较,差异有统计学意义(P=0.003).肝组织HBcAg分为核型、浆型、浆核型、阴性4种,HBeAg阳性慢性乙型肝炎患者中,HBcAg阳性表达率为80.33％(40/48) ;HBeAg阴性慢性乙型肝炎患者,HBcAg阳性表达率为53.33％ (8/15),两组比较,差异有统计学意义(P值均＜0.05).在HBeAg阳性的慢性乙型肝炎患中HBV DNA滴度,HBcAg核浆混合型患者高于浆型患者(P=0.008),高于阴性患者(P=0.013); HBcAg核型患者高于浆型患者(P=0.019).HBeAg阳性慢性乙型肝炎患者,HBV DNA滴度与HBcAg的核浆混合型表达等级呈正相关(r=0.589,P=0.003),与小叶内炎症、界面炎症、肝纤维化等级呈负相关(r值分别为-0.552、-0.381、-0.555,P值均＜0.05);外周血淋巴细胞数量与小叶内炎症、纤维化等级呈负相关(r值分别为-0.361、-0.356,P值均＜0.05).HBeAg阴性慢性乙型肝炎患者,外周血淋巴细胞数与小叶内炎症(r=-0.702,P=0.004)、界面炎症等级(r=-0.578,P=0.024)呈负相关;外周血单核细胞数与小叶内炎症、界面炎症和肝纤维化等级呈负相关(r值分别为-0.682、-0.620、-0.527,P值均＜0.05);年龄与界面性炎呈正相关(r=0.690,P=0.004). 结论 HBcAg的核浆混合型表达类型可以反映病毒的复制水平,其阴性表达可能与前C区或C区的变异有关,单核巨噬细胞系统可能参与HBeAg阴性慢性乙型肝炎的病理损伤,HBV DNA滴度在HBeAg阴性慢性乙型肝炎患者中的增高,可能与免疫逃逸有关.
目的 探討慢性乙型肝炎患者肝組織中HBcAg的錶達類型與HBV DNA複製及炎癥損傷的關繫,分析HBeAg暘性或陰性慢性乙型肝炎患者的臨床病理學特點與HBcAg的錶達差異.方法 迴顧性分析63例通過肝穿刺病理學診斷的慢性乙型肝炎患者資料,肝組織病理學及HBcAg錶達與外週血淋巴細胞數量、單覈細胞數量、HBV DNA載量的關繫.連續計量資料符閤正態分佈、且方差齊者,採用獨立樣本T檢驗;非正態分佈採用非參數檢驗(Mann-Whitney U檢驗);計數資料通過x2或Fishers精確概率檢驗;連續變量之間採用Pearson相關分析,等級變量之間比較採用Spearman等級相關分析. 結果 63例肝穿刺患者中,HBeAg暘性慢性乙型肝炎患者48例,HBV DNA中位滴度為5.4×106拷貝/ml,HBeAg陰性慢性乙型肝炎患者15例,HBV DNA中位滴度為5.4×104拷貝/ml,兩組比較,差異有統計學意義(P=0.003).肝組織HBcAg分為覈型、漿型、漿覈型、陰性4種,HBeAg暘性慢性乙型肝炎患者中,HBcAg暘性錶達率為80.33％(40/48) ;HBeAg陰性慢性乙型肝炎患者,HBcAg暘性錶達率為53.33％ (8/15),兩組比較,差異有統計學意義(P值均＜0.05).在HBeAg暘性的慢性乙型肝炎患中HBV DNA滴度,HBcAg覈漿混閤型患者高于漿型患者(P=0.008),高于陰性患者(P=0.013); HBcAg覈型患者高于漿型患者(P=0.019).HBeAg暘性慢性乙型肝炎患者,HBV DNA滴度與HBcAg的覈漿混閤型錶達等級呈正相關(r=0.589,P=0.003),與小葉內炎癥、界麵炎癥、肝纖維化等級呈負相關(r值分彆為-0.552、-0.381、-0.555,P值均＜0.05);外週血淋巴細胞數量與小葉內炎癥、纖維化等級呈負相關(r值分彆為-0.361、-0.356,P值均＜0.05).HBeAg陰性慢性乙型肝炎患者,外週血淋巴細胞數與小葉內炎癥(r=-0.702,P=0.004)、界麵炎癥等級(r=-0.578,P=0.024)呈負相關;外週血單覈細胞數與小葉內炎癥、界麵炎癥和肝纖維化等級呈負相關(r值分彆為-0.682、-0.620、-0.527,P值均＜0.05);年齡與界麵性炎呈正相關(r=0.690,P=0.004). 結論 HBcAg的覈漿混閤型錶達類型可以反映病毒的複製水平,其陰性錶達可能與前C區或C區的變異有關,單覈巨噬細胞繫統可能參與HBeAg陰性慢性乙型肝炎的病理損傷,HBV DNA滴度在HBeAg陰性慢性乙型肝炎患者中的增高,可能與免疫逃逸有關.
목적 탐토만성을형간염환자간조직중HBcAg적표체류형여HBV DNA복제급염증손상적관계,분석HBeAg양성혹음성만성을형간염환자적림상병이학특점여HBcAg적표체차이.방법 회고성분석63례통과간천자병이학진단적만성을형간염환자자료,간조직병이학급HBcAg표체여외주혈림파세포수량、단핵세포수량、HBV DNA재량적관계.련속계량자료부합정태분포、차방차제자,채용독립양본T검험;비정태분포채용비삼수검험(Mann-Whitney U검험);계수자료통과x2혹Fishers정학개솔검험;련속변량지간채용Pearson상관분석,등급변량지간비교채용Spearman등급상관분석. 결과 63례간천자환자중,HBeAg양성만성을형간염환자48례,HBV DNA중위적도위5.4×106고패/ml,HBeAg음성만성을형간염환자15례,HBV DNA중위적도위5.4×104고패/ml,량조비교,차이유통계학의의(P=0.003).간조직HBcAg분위핵형、장형、장핵형、음성4충,HBeAg양성만성을형간염환자중,HBcAg양성표체솔위80.33％(40/48) ;HBeAg음성만성을형간염환자,HBcAg양성표체솔위53.33％ (8/15),량조비교,차이유통계학의의(P치균＜0.05).재HBeAg양성적만성을형간염환중HBV DNA적도,HBcAg핵장혼합형환자고우장형환자(P=0.008),고우음성환자(P=0.013); HBcAg핵형환자고우장형환자(P=0.019).HBeAg양성만성을형간염환자,HBV DNA적도여HBcAg적핵장혼합형표체등급정정상관(r=0.589,P=0.003),여소협내염증、계면염증、간섬유화등급정부상관(r치분별위-0.552、-0.381、-0.555,P치균＜0.05);외주혈림파세포수량여소협내염증、섬유화등급정부상관(r치분별위-0.361、-0.356,P치균＜0.05).HBeAg음성만성을형간염환자,외주혈림파세포수여소협내염증(r=-0.702,P=0.004)、계면염증등급(r=-0.578,P=0.024)정부상관;외주혈단핵세포수여소협내염증、계면염증화간섬유화등급정부상관(r치분별위-0.682、-0.620、-0.527,P치균＜0.05);년령여계면성염정정상관(r=0.690,P=0.004). 결론 HBcAg적핵장혼합형표체류형가이반영병독적복제수평,기음성표체가능여전C구혹C구적변이유관,단핵거서세포계통가능삼여HBeAg음성만성을형간염적병리손상,HBV DNA적도재HBeAg음성만성을형간염환자중적증고,가능여면역도일유관.
Objective To investigate the relationship between the expression of hepatitis B virus (HBV) core antigen and viral replication and liver tissue inflammation damage in chronic hepatitis B (CHB)patients,and to analyze the relationship of core antigen expression differences with clinical and pathological features in e antigen-negative and e antigen-positive CHB patients.Methods Sixty-three treatmentnaive patients diagnosed with CHB who underwent liver biopsy were included in this retrospective analysis.Liver pathology was assessed,and the karyotype,pulp type,and pulp karyotype were determined.Core and e antigen expression was quantitatively determined by automated immunoassay.Blood samples were used to determine the amount of peripheral lymphocytes or monocytes and HBV DNA load.Results The median titer of HBV DNA was significantly higher in the CHB patients with e antigen positivity (n =48) than those with e antigen negativity (n =15) (5.4 × 106 copies/ml vs.5.4 × 104copies/ml,P =0.003).The core antigen positive expression rate was significantly higher in the e antigen-positive CHB patients than in the e antigen-negative CHB patients (80.33％ vs.53.33％,P =0.042).For the e antigen-positive CHB patients,the HBV DNA titer in karyotype core antigen cases was higher than that in the pulp karyotype mixed-type cases (P =0.008) and in the negative cases (P =0.013); in addition,the karyotype patients showed higher titer than the plasma patients (P =0.019).Also for the e antigen-positive CHB patients,the HBV DNA titer was positively correlated with the rank level of pulp karyotype in core antigen expression (r =0.589,P =0.003) but negatively correlated with lobular inflammation,interface inflammation,and fibrosis level (r =-0.552,P =0.000; r =-0.381,P =0.008; r =-0.555,P =0.000); in addition,the level of peripheral blood lymphocytes was negatively correlated with lobular inflammation and fibrosis level (r =-0.36 1,P =0.012; r =-0.356,P =0.013).For the e antigen-negative CHB patients,the level of peripheral blood lymphocytes was negatively correlated with lobular inflammation and interface inflammation (r =-0.702,P =0.004; r =-0.578,P =0.024),while the level of peripheral blood mononuclear cells was negatively correlated with lobular inflammation,interface inflammation,and fibrosis level (r =-0.682,P =0.005; r =-0.620,P =0.014; r =-0.527,P =0.044); in addition,age positively correlated with interface inflammation (r =0.690,P =0.004).Conclusion The pulp karyotype mixed-type of core antigen expression may reflect the level of HBV replication.Negative expression of core antigen may be associated with variation in pre-C or C zone.The monocyte-macrophage system may be involved in the pathogenesis of e antigen-negative CHB,while the mechanism of immune escape may play an important role in increasing HBV DNA titer in an e-antigen-negative CHB condition.
