中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2013年
8期
575-579
,共5页
刘静%刘婷%吴元凯%柯伟民%邓子德%高志良
劉靜%劉婷%吳元凱%柯偉民%鄧子德%高誌良
류정%류정%오원개%가위민%산자덕%고지량
肝炎,乙型,慢性%肝炎表面抗原,乙型%病毒载量
肝炎,乙型,慢性%肝炎錶麵抗原,乙型%病毒載量
간염,을형,만성%간염표면항원,을형%병독재량
Hepatitis B,Chronic%Hepatitis B surface antigens%Viral load
目的 了解慢性乙型肝炎急性加重患者自然恢复和短期抗病毒干预过程中的乙型肝炎表面抗原定量(HBsAg)动力学变化趋势. 方法 慢性乙型肝炎急性加重接受恩替卡韦抗HBV治疗的39例患者为A组,未接受任何抗HBV治疗的22例患者为B组,分别在入院时(基线)、极期[终末期肝病模型(MELD)评分分值最高时]、恢复期(出院前)计算MELD评分,并检测HBV DNA载量和HBsAg定量,分别比较两组之间疾病三个时期的MELD评分、HBV DNA载量和HBsAg定量；并且进行同一组内三个时期之间的两两比较.两组间均数比较采用t检验,两组内均数的两两比较采用配对t检验的BONFERRONI法,计数资料(n＜40)采用Fisher精确概率法检验.结果 A组入院时、极期、恢复期HBsAg定量分别为(3.68±0.45)log10COI,(3.84±0.19)log10COI和(3.69±0.58) log10COI;B组HBsAg定量分别为(3.59±0.54) log10COI,(3.47±0.76)log10COI和(3.43±0.68)log10COI.A组和B组之间疾病三个时期MELD评分、HBV DNA载量和HBsAg定量比较,除A组HBV DNA极期和恢复期水平低于B组外(P值均＜0.05),其余差异均无统计学意义(P值均＞ 0.05).抗HBV治疗组中,MELD评分于基线和极期均高于恢复期水平(P=0.000),但基线和极期比较,差异无统计学意义(P=1.000)；HBV DNA载量自基线、极期至恢复期逐渐下降,两两比较,差异均有统计学意义(P值均＜ 0.05)；HBsAg定量三者之间两两比较,差异均无统计学意义(P值均＞ 0.05).非抗HBV治疗组中,MELD评分基线和极期均高于恢复期水平(P=0.000),但基线和极期比较,差异无统计学意义(P=1.000)；HBV DNA载量基线和极期均高于恢复期水平(P值分别为0.000和0.003),但基线和极期比较,差异无统计学意义(P=0.619)；HBsAg定量三者之间两两比较,差异均无统计学意义(P值均＞0.05). 结论 慢性乙型肝炎急性加重患者自然康复过程中,HBsAg定量没有变化；即使进行短期抗HBV治疗干预,HBsAg定量也不受影响.
目的 瞭解慢性乙型肝炎急性加重患者自然恢複和短期抗病毒榦預過程中的乙型肝炎錶麵抗原定量(HBsAg)動力學變化趨勢. 方法 慢性乙型肝炎急性加重接受恩替卡韋抗HBV治療的39例患者為A組,未接受任何抗HBV治療的22例患者為B組,分彆在入院時(基線)、極期[終末期肝病模型(MELD)評分分值最高時]、恢複期(齣院前)計算MELD評分,併檢測HBV DNA載量和HBsAg定量,分彆比較兩組之間疾病三箇時期的MELD評分、HBV DNA載量和HBsAg定量；併且進行同一組內三箇時期之間的兩兩比較.兩組間均數比較採用t檢驗,兩組內均數的兩兩比較採用配對t檢驗的BONFERRONI法,計數資料(n＜40)採用Fisher精確概率法檢驗.結果 A組入院時、極期、恢複期HBsAg定量分彆為(3.68±0.45)log10COI,(3.84±0.19)log10COI和(3.69±0.58) log10COI;B組HBsAg定量分彆為(3.59±0.54) log10COI,(3.47±0.76)log10COI和(3.43±0.68)log10COI.A組和B組之間疾病三箇時期MELD評分、HBV DNA載量和HBsAg定量比較,除A組HBV DNA極期和恢複期水平低于B組外(P值均＜0.05),其餘差異均無統計學意義(P值均＞ 0.05).抗HBV治療組中,MELD評分于基線和極期均高于恢複期水平(P=0.000),但基線和極期比較,差異無統計學意義(P=1.000)；HBV DNA載量自基線、極期至恢複期逐漸下降,兩兩比較,差異均有統計學意義(P值均＜ 0.05)；HBsAg定量三者之間兩兩比較,差異均無統計學意義(P值均＞ 0.05).非抗HBV治療組中,MELD評分基線和極期均高于恢複期水平(P=0.000),但基線和極期比較,差異無統計學意義(P=1.000)；HBV DNA載量基線和極期均高于恢複期水平(P值分彆為0.000和0.003),但基線和極期比較,差異無統計學意義(P=0.619)；HBsAg定量三者之間兩兩比較,差異均無統計學意義(P值均＞0.05). 結論 慢性乙型肝炎急性加重患者自然康複過程中,HBsAg定量沒有變化；即使進行短期抗HBV治療榦預,HBsAg定量也不受影響.
목적 료해만성을형간염급성가중환자자연회복화단기항병독간예과정중적을형간염표면항원정량(HBsAg)동역학변화추세. 방법 만성을형간염급성가중접수은체잡위항HBV치료적39례환자위A조,미접수임하항HBV치료적22례환자위B조,분별재입원시(기선)、겁기[종말기간병모형(MELD)평분분치최고시]、회복기(출원전)계산MELD평분,병검측HBV DNA재량화HBsAg정량,분별비교량조지간질병삼개시기적MELD평분、HBV DNA재량화HBsAg정량；병차진행동일조내삼개시기지간적량량비교.량조간균수비교채용t검험,량조내균수적량량비교채용배대t검험적BONFERRONI법,계수자료(n＜40)채용Fisher정학개솔법검험.결과 A조입원시、겁기、회복기HBsAg정량분별위(3.68±0.45)log10COI,(3.84±0.19)log10COI화(3.69±0.58) log10COI;B조HBsAg정량분별위(3.59±0.54) log10COI,(3.47±0.76)log10COI화(3.43±0.68)log10COI.A조화B조지간질병삼개시기MELD평분、HBV DNA재량화HBsAg정량비교,제A조HBV DNA겁기화회복기수평저우B조외(P치균＜0.05),기여차이균무통계학의의(P치균＞ 0.05).항HBV치료조중,MELD평분우기선화겁기균고우회복기수평(P=0.000),단기선화겁기비교,차이무통계학의의(P=1.000)；HBV DNA재량자기선、겁기지회복기축점하강,량량비교,차이균유통계학의의(P치균＜ 0.05)；HBsAg정량삼자지간량량비교,차이균무통계학의의(P치균＞ 0.05).비항HBV치료조중,MELD평분기선화겁기균고우회복기수평(P=0.000),단기선화겁기비교,차이무통계학의의(P=1.000)；HBV DNA재량기선화겁기균고우회복기수평(P치분별위0.000화0.003),단기선화겁기비교,차이무통계학의의(P=0.619)；HBsAg정량삼자지간량량비교,차이균무통계학의의(P치균＞0.05). 결론 만성을형간염급성가중환자자연강복과정중,HBsAg정량몰유변화；즉사진행단기항HBV치료간예,HBsAg정량야불수영향.
Objective To investigate the dynamic quantitative changes in expression of hepatitis B virus (HBV) surface antigen (HBsAg) that occurs during the natural recovery course and the shortterm antivirus treatment period of patients suffering from flares in chronic hepatitis B (CHB).Methods CHB patients presenting for treatment of flare-ups were randomly assigned to receive treatment with Enticavir antiviral (group A,n =39) or to naturally resolve the acute condition (group B,n =22).All patients MELD scores were calculated and HBsAg levels and HBV DNA loads were measured upon admission (baseline),at worst-condition stage,and end of treatment/flare-up (discharge).Pairwise comparisons of intergroup differences were made to evaluate the change in the three disease parameters over time in response to the management approach.Results The levels of HBsAg were not significantly different between the two groups at baseline,worst-condition stage and discharge (group A:(3.68 ± 0.45),(3.84 ± 0.19) and (3.69 ± 0.58) log10 cut-offindex (COI) respectively; group B:(3.59 ± 0.54),(3.47 ± 0.76)and (3.43 ± 0.68) log10 COI respectively; all P ＞ 0.05).However,the HBV DNA loads were significantly lower in group A than in group B at the worst-condition stage and at discharge (all P ＜ 0.05).In group A,the MELD scores were significantly higher at baseline and at worst-condition stage than at discharge (all P =0.000),but the difference between baseline and worst-condition stage was not significant.Also in group A,the HBV DNA load showed a gradually decreasing trend over time (baseline ＞ worst-condition stage ＞ discharge,all P ＜ 0.05).No significant differences were observed over time in the HBsAg levels of group A.In group B,the MELD scores were significantly higher at baseline and at worst-condition stage than at discharge (allP =0.000),but the difference between baseline and worst-condition stage was not significant (P =0.619).Also in group B,the HBV DNA loads were significantly higher at baseline and worst-condition stage than at discharge (P =0.000 and P =0.003 respectively),but the difference between baseline and worst-condition stage was not significant.Finally,no significant differences were observed over time in the HBsAg levels of group B.Conclusion Natural recovery from an acute flare-up of CHB is not accompanied by a change in HBsAg levels.In addition,short-term antiviral treatment to resolve the flare-up has no influence on HBsAg level.
