146例乙型肝炎患者HBsAg转阴的临床分析

发布时间：2018-03-24 22:36

本文选题：肝炎　切入点：肝硬化　出处：《肝脏》2016年06期

【摘要】：目的研究乙型肝炎患者HBsAg转阴的相关规律。方法对146例乙型肝炎HBsAg转阴者,应用SPSS19.0软件进行统计学处理分析。结果男性组有乙型肝炎家族史72例(59.0%),女性组有乙型肝炎家族史11例(45.8%)。HBsAg转阴时平均年龄分别为急性乙型肝炎(41.3±10.2)岁、慢性乙型肝炎(45.0±12.5)岁、早期肝硬化(57.2±16.1)岁、肝癌(54.8±11.6)岁、肝硬化失代偿(56.5±12.5)岁。急性肝炎与早期肝硬化,肝癌,肝硬化失代偿分别进行独立样本t检验,t值分别-2.884,-3.511,-4.463,P值分别0.007,0.001,0.000;慢性肝炎与早期肝硬化,肝癌,肝硬化失代偿分别进行独立样本t检验,t值分别-2.081,-2.458,-3.638,P值分别0.04,0.016,0.000。抗病毒治疗情况分别为急性乙型肝炎9/25例(36%),慢性乙型肝炎41/121例(33.8%),其中肝硬化失代偿、肝癌、慢性重症肝炎3/30例(10%)。按年龄分析抗病毒治疗情况,30岁6/13(46.1%)、30~40岁12/34(35.2%)、40~50岁18/47(38.2%)、50~60岁11/30(36.6%)、60~80岁5/22(22.7%)。按慢性乙型肝炎年龄分析未抗病毒治疗HBsAg自然转阴情况,30岁5/11(45.4%)、30~40岁13/23(56.5%)、40~50岁24/37(64.8%)、50~60岁17/28(60.7%)、60~80岁17/22(77.2%)。HBsAg转阴时间以急性乙型肝炎抗病毒治疗者最快,其次为急性乙型肝炎未抗病毒治疗者。HBsAg转阴后,HBsAb1 280 mIU/mL8例、300~1280 mIU/mL12例、100~300 mIU/mL11例、20~100 mIU/mL12例、6.4~20 mIU/mL11例、6例HBsAg转阴后反弹。结论 HBsAg有一定的自然转阴率,与年龄显著相关;抗病毒治疗可促进急性与慢性乙型肝炎患者HBsAg转阴;未抗病毒治疗患者HBsAg转阴时肝硬化失代偿、肝癌、慢性重症肝炎发生率较高;应重视抗病毒治疗,但目前不宜将HBsAg转阴作为乙型肝炎的主要治疗目标。
[Abstract]:Objective to study the rule of HBsAg negative conversion in patients with hepatitis B. methods 146 patients with hepatitis B HBsAg turned negative, Results 72 cases of hepatitis B family history in male group and 11 cases with hepatitis B family history in female group were 41.3 卤10.2 years old in acute hepatitis B group and 45.0 卤12.5 years old in chronic hepatitis B group, respectively. Early cirrhosis was 57.2 卤16.1 years old, liver cancer 54.8 卤11.6 years old, liver cirrhosis decompensated 56.5 卤12.5 years old. T test of acute hepatitis and early liver cirrhosis, liver cancer and cirrhosis decompensation were carried out by independent t test (P = 0.0070.0010.000 respectively), chronic hepatitis and early cirrhosis, liver cancer, liver cirrhosis decompensation (P = 0.0070.0010.000). The t value of independent sample t test for decompensation of liver cirrhosis was -2.081U -2.458U -3.638g P respectively 0.04% 0.0160.000.The antiviral treatment was as follows: acute hepatitis B 925 cases 36%, chronic hepatitis B 41% 121 cases 33.8%, among which liver cirrhosis was decompensated, liver cancer was decompensated. Analysis of antiviral therapy by age in patients with chronic severe hepatitis at the age of 6 / 13 / 46.1T = 30 / 30 / 12 / 34 / 35.28.2 / 50, 18 / 4738.2 / 50 / 50 / 1130 / 36.6 / 60, 5222222.70.Analyzed on the age of chronic hepatitis B to analyze the natural conversion of HBsAg by age: 51145.45.45.45.45.45.45.45.45 / 3040 / 3040 years old 2437 / 66.4050 years old 2437 / 64.860 years old 17 / 60 years old / 28660 years old / 80 years / year old / 80 years / year old / year / year / year / year / year / year / year / year / year / year / year, / year / year / year, / year / year / year / year / year old / year old, / year old / year / year old / year old / year old, #number0# / 70 / 60 / 70 / 60 / 60 / 70 / 70 / 60 / 70 / 70. Among the patients with acute hepatitis B, antiviral therapy is the fastest. Secondly, 1 280 mIU/mL8 patients with acute hepatitis B, 1 280 mIU/mL8, 1 280 mIU/mL12, 1 280 mIU/mL12, 20 #number0# mIU/mL12, 6 mIU/mL11, 6 HBsAg turned negative and rebounded. Conclusion HBsAg has a certain natural negative conversion rate, which is significantly correlated with age. Antiviral therapy can promote the conversion of HBsAg to negative in patients with acute and chronic hepatitis B. liver cirrhosis decompensation, liver cancer and chronic severe hepatitis should be paid more attention to when HBsAg turns negative in patients without antiviral therapy. However, it is not suitable to turn HBsAg negative as the main treatment target of hepatitis B at present.
【作者单位】：解放军第八二医院感染内科;
【分类号】：R512.62

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