CAJ | 학술논문

目的了解慢性乙型肝炎患儿血清乙型肝炎病毒共价闭合环状DNA(hepatitis B virus covalently closed circle DNA,HBV cccDNA)与病情、肝功能指标及肝组织病理变化的关系.方法选择HBV-DNA阳性124例乙型肝炎患儿,其中携带者65例,慢性乙型肝炎59例(轻度31例、中度18例、重度10例),检测其血清HBV cccDNA及肝功能,对其中的46例患儿进行了肝脏穿刺,对肝组织进行炎症分级及纤维化分级.结果中、重度慢性乙型肝炎患儿血清HBV cccDNA阳性率(77.8％、100％)高于携带者和轻度组(32.3％、54.8％)(x2=25.429,P＜0.01),患儿病情越重外周血HBV cccDNA检出率越高.血清HBV cccDNA阳性组的谷丙转氨酶、谷草转氨酶、总胆红素[(95.6±18.2) U/L、(88.8±20.3)U/L、(68.4±24.6)μmol/L]均高于阴性组[(52.5±17.7) U/L、(48.4±21.4) U/L、(28.3±23.9) μmol/L](t=15.572、10.750、17.067,P均＜0.01).血清cccDNA与肝组织炎症活动度和纤维化程度无明显相关性.结论血清HBV cccDNA是代表病毒复制的一个敏感指标,病情越重,外周血HBVcccDNA检出率越高,但其与肝组织炎症及纤维化并非完全一致,所以其不能完全反映肝脏的损伤程度.
목적 료해만성을형간염환인혈청을형간염병독공개폐합배상DNA(hepatitis B virus covalently closed circle DNA,HBV cccDNA)여병정、간공능지표급간조직병리변화적관계.방법 선택HBV-DNA양성124례을형간염환인,기중휴대자65례,만성을형간염59례(경도31례、중도18례、중도10례),검측기혈청HBV cccDNA급간공능,대기중적46례환인진행료간장천자,대간조직진행염증분급급섬유화분급.결과 중、중도만성을형간염환인혈청HBV cccDNA양성솔(77.8％、100％)고우휴대자화경도조(32.3％、54.8％)(x2=25.429,P＜0.01),환인병정월중외주혈HBV cccDNA검출솔월고.혈청HBV cccDNA양성조적곡병전안매、곡초전안매、총담홍소[(95.6±18.2) U/L、(88.8±20.3)U/L、(68.4±24.6)μmol/L]균고우음성조[(52.5±17.7) U/L、(48.4±21.4) U/L、(28.3±23.9) μmol/L](t=15.572、10.750、17.067,P균＜0.01).혈청cccDNA여간조직염증활동도화섬유화정도무명현상관성.결론 혈청HBV cccDNA시대표병독복제적일개민감지표,병정월중,외주혈HBVcccDNA검출솔월고,단기여간조직염증급섬유화병비완전일치,소이기불능완전반영간장적손상정도.
Objective To study the relationship between serum hepatitis B virus covalently closed circle DNA (HBV cccDNA) as well as liver function and liver tissue pathological changes in children with chronic hepatitis B.Methods One hundred and twenty-four HBV-DNA positive children with hepatitis B were enrolled.Among 124 patients,65 cases were HBV carriers,59 cases were chronic hepatitis (mild in 31 cases,moderate in 18 cases and severe in 10 cases).HBV cccDNA in serum and liver function were detected,46 of which underwent liver biopsy and liver tissue inflammation and fibrosis grading classification was made.Results In moderate and severe cases,positive rates of serum HBV cccDNA (77.8％,100％) were higher than those of the HBV carriers and mild cases (32.3％,54.8％) (x2 =25.429,P ＜ 0.01),indicating more severe illness in children,detection rate of serum HBV cccDNA was higher.ALT,AST,and TBIL were higher in serum HBV cccDNA positive group than those of negative group[(95.6 ± 18.2) U/L vs (52.5 ± 17.7) U/L,(88.8 ±20.3) U/L vs (48.4 ±21.4) U/L,(68.4 ±24.6) μmol/L vs (28.3 ± 23.9) μmol/L](t =15.572,10.750,17.067,P ＜ 0.01).Serum HBV cccDNA and liver inflammatory activity and fibrosis showed no significant correlationship.Conclusion Serum HBV cccDNA is a sensitive indicator of viral replication,the more severe the disease situation,the peripheral HBV cccDNA detection rate is higher.But it is not entirely consistent with liver inflammation and fibrosis,so it can not completely reflect the degree of liver damage.