乙肝相关性肝衰竭HBV-DNA低水平复制及特异性抗体表达临床研究

发布时间：2018-02-05 05:14

本文关键词： 肝功能衰竭肝炎乙型慢性 HBV-DNA 抗体乙型肝炎病毒　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：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,为HBV相关性肝衰竭患者评价预后提供依据。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。1.比较乙型肝炎相关性肝衰竭与慢性乙型肝炎HBV-DNA表达的不同及影响因素分析。 2.根据HBV-Ms特异性表达的不同将肝衰竭患者分为特异性抗体阳性(指HBsAb、HBeAb和HBcAb同时阳性)和特异性抗体阴性(无HBsA、HBeAb和HBcAb同时阳性)两组,分析2组患者HBV-DNA含量的变化和生存情况。 3.比较乙型肝炎相关性肝衰竭与慢性乙型肝炎患者及肝衰竭2组患者之间免疫功能的不同。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x2检验。结果：1.391例肝衰竭患者中,急性肝衰竭患者26例,亚急性肝衰竭14例,慢加急性(亚急性)肝衰竭285例,慢性肝衰竭66例。其中,慢加急性(亚急性)肝衰竭患者最多,占所有肝衰竭患者的72.89%。特异性阳性组和阴性组肝衰竭患者的类型构成分布差异无统计学意义(P0.05)。 2.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,P0.05)；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,P0.05)。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%),两组病死率差异有统计学意义(P0.05)。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,P0.05)。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,P0.05)。 3.与慢性乙型肝炎患者相比,肝衰竭患者免疫功能IgG、IgA、IgM及C34项检测结果有显著性差异(P0.05),其中肝衰竭组IgG、IgA、IgM明显高于慢性乙型肝炎组和正常参考范围,而C3则明显低于慢性乙型肝炎组和正常参考范围,差异有统计学意义,其中HBV特异性抗体阳性组与HBV特异性抗体阴性组相比在IgG、IgA、IgM检测指标上差异无统计学意义(P0.05),而C3结果低于HBV特异性抗体阴性组,差异有统计学意义(P0.05)。结论：HBV-Ms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三个抗体同时阳性则提示机体对乙型肝炎病毒的超强免疫反应,致使病情恶化、发展迅速,病死率高。因此,加强健康教育、督促患者定期复查对于肝衰竭患者的防治十分重要。
[Abstract]:Objective: to investigate the clinical significance of the low level replication of serum HBV-DNA and the expression of HBV specific antibody in patients with hepatitis B associated liver failure. To provide a basis for evaluating the prognosis of patients with HBV associated liver failure. Methods:. The medical records of 391 patients with hepatitis B related liver failure and 394 patients with chronic hepatitis B were collected from June 2008 to December 2013 in Tianjin second people's Hospital. To compare the difference of HBV-DNA expression between hepatitis B associated liver failure and chronic hepatitis B and the analysis of influencing factors. 2. According to the specific expression of HBV-Ms, the patients with liver failure were divided into specific antibody positive (HBsAb). Both HBeAb and HBcAb were positive and the specific antibody was negative (no HBsAg HBeAb and HBcAb were positive). The changes of HBV-DNA content and survival in two groups were analyzed. 3. To compare the difference of immune function between hepatitis B associated liver failure patients and chronic hepatitis B patients and liver failure patients. Independent sample t test or Mann-Whitney rank sum were used in the comparison between groups. Test. The count data were compared by x 2 test. Results among the 391 cases of liver failure, 26 were acute hepatic failure, 14 subacute liver failure, 285 slow plus acute liver failure and 66 chronic liver failure. Patients with chronic and acute (subacute) liver failure were the most. 72.89% of all patients with liver failure. There was no significant difference in the distribution of type composition between the specific positive group and the negative group. 2.The level of HBV-DNA in patients with hepatitis B associated liver failure was lower than that in patients with chronic hepatitis B, and the difference was statistically significant (P 0.05). The levels of HBV-DNA in HBeAg positive and negative liver failure patients were lower than those in corresponding chronic hepatitis B patients, the difference being -11.665 and -12.853 respectively. In 391 cases of liver failure, 29 cases were positive for HBV specific antibody, and 25 cases died (86.21%). In the HBV specific antibody negative group, 362 cases (92. 58%) and 157 cases died (43. 37%). There was a significant difference in mortality between the two groups (P 0.05). The level of HBV-DNA in the positive group was significantly lower than that in the negative group. The level of HBV-DNA in HBeAg negative group was lower than that in HBeAg positive group. The differences were 7.427 and 7.513 (P 0.05), respectively. 3.Compared with the patients with chronic hepatitis B, the immunological function of patients with liver failure was significantly higher than that of patients with chronic hepatitis B (P 0.05). IgA IgM was significantly higher than chronic hepatitis B group and normal reference range, while C3 was significantly lower than chronic hepatitis B group and normal reference range, the difference was statistically significant. The HBV specific antibody positive group and the HBV specific antibody negative group had no significant difference in the IgG specific antibody detection index (P0.05). But the C 3 result was lower than that of HBV specific antibody negative group, the difference was statistically significant (P 0.05). Conclusion the expression of HBV-Ms and the dynamic changes of immune state play an important role in the occurrence and development of hepatitis B related liver failure. The low level replication of HBV-DNA is caused by immune clearance, and it is accompanied by anti-HBs and anti-HBe. Anti-HBc antibody positive at the same time indicates that the body to hepatitis B virus super-strong immune response, leading to the deterioration of the disease, rapid development, high mortality. Therefore, strengthen health education. It is very important to urge patients to review regularly for the prevention and treatment of liver failure.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.62;R575.3

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