HBV-DNA及HBsAg定量对低病毒载量慢性乙肝的临床意义

发布时间：2018-02-23 06:07

本文关键词： HBV 慢性乙型肝炎 HBV DNA载量 HBsAg定量　出处：《浙江大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：因检测方法学所限,对低病毒血症(HBV DNA2000IU/mL)慢性乙肝患者的外周血HBV DNA载量和HBsAg水平的研究甚少。本课题旨对患者进行精确的HBV DNA载量测定,结合HBsAg定量、年龄、性别、ALT等观察指标分析二者在慢性HBV感染不同阶段及病程进展和转归中的预测作用和临床意义。方法：回顾分析从2011年1月至2013年12月期间在我院就诊的4087例慢性乙肝患者的临床检测和病例资料,其中门诊3751例,住院336例,病史及HBsAg阳性均在半年以上。对外周血HBV DNA采用Cobas AmpliPrep/Cobas TaqMan高敏核酸定量系统检测,HBsAg定量采用雅培的Architect HBsAg试剂盒。分析指标主要包括HBV DNA. HBsAg. ALT.年龄、性别,从中随机筛选符合观察标准的1873例样本进行分析。结果： 1.在4087例经治慢乙肝患者中有3553例(86.93%)为HBV DNA2,000IU/mL(含20IU/mL),有51.72%20IU/mL;在1873例有效病例中,HBeAg(-)患者占74.96%(1404例)。 2.不同HBV DNA载量组别间HBsAg水平分布差异均有统计学意义；相同HBVDNA载量组别内的HBeAg(+)组与HBeAg(-)组间HBsAg水平分布差异也均有统计学意义。提示HBV DNA、HBsAg定量可作为独立或联合的抗病毒疗效预测指标。 3.对极低病毒载量(HBV DNA20IU/mL)的慢乙肝患者而言,HBsAg可能是更好的观察和预测指标。 4.不同HBVDNA载量组别间肝硬化、原发性肝癌发生率差异均无统计学意义,可能与阳性病例较少有关。 5.采用Cobas AmpliPrep/Cobas TaqMan高灵敏度核酸定量方法有助于发现HBsAg(-)HBV DNA(+)的隐匿性慢性乙肝患者。结论：采用更敏感的方法检测HBV DNA有助于更好的了解低病毒载量慢性乙肝患者的病毒复制情况和抗病毒治疗过程中病毒的清除速率,可发现隐匿性感染；对HBV DNA2000IU/mL的慢性乙肝患者,HBsAg水平结合HBV DNA载量可更好地预测病程的进展和转归。对HBV DNA20IU/mL的慢性乙肝患者而言,HBsAg可能是更好的观察和预测指标。
[Abstract]:Objective: to study the HBV DNA load and HBsAg level in peripheral blood of patients with chronic hepatitis B with hypoviremia and HBV-2000 IUU / mL due to the limitation of detection methodology. The purpose of this study was to carry out accurate HBV DNA load measurement, combined with HBsAg quantification and age, in patients with chronic hepatitis B. The clinical significance of the two indexes in predicting the progression and outcome of chronic HBV infection at different stages, progression and outcome were analyzed. Methods: the clinical examination and data of 4 087 patients with chronic hepatitis B from January 2011 to December 2013 in our hospital were analyzed retrospectively. The disease history and HBsAg positive rate were more than half a year. Cobas AmpliPrep/Cobas TaqMan Gao Min nucleic acid quantitative system was used to detect HBV DNA in peripheral blood. Architect HBsAg kit was used to detect Cobas AmpliPrep/Cobas TaqMan Gao Min. The analysis indexes mainly included age and sex of HBV DNA. HBsAg Ag. alt. A total of 1873 samples that met the observation criteria were selected for analysis. Results:. 1. Among 4087 patients with chronic hepatitis B, 3 553 cases (86.93 cases) were HBV DNA2 000 IUR / mL (including 20 IUU / mLN, 51.72 IUR / mLand 74.96% of 1873 effective cases). 2. There were significant differences in the distribution of HBsAg levels among different HBV DNA load groups. There were also significant differences in the distribution of HBsAg levels between HBeAg- () and HBeAg- groups in the same HBVDNA load group, suggesting that the quantification of HBsAg could be used as an independent or combined predictor of antiviral efficacy. 3. HBsAg may be a better index for observation and prediction of chronic hepatitis B patients with very low viral load and HBV DNA 20IUmL. 4. There was no significant difference in the incidence of liver cirrhosis and primary liver cancer among different HBVDNA load groups, which might be related to the small number of positive cases. 5. Using Cobas AmpliPrep/Cobas TaqMan high sensitivity nucleic acid quantitative method is helpful to identify occult chronic hepatitis B patients with HBsAg(-)HBV DNA. Conclusion: detection of HBV DNA by a more sensitive method is helpful to better understand the viral replication in patients with chronic hepatitis B with low viral load and the rate of virus clearance during antiviral therapy, and occult infection can be found. The level of HBV combined with the load of HBV DNA in chronic hepatitis B patients with HBV DNA2000IU/mL can better predict the progression and outcome of the disease course, and it may be a better index for the observation and prediction of HBV DNA20IU/mL patients with chronic hepatitis B.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.62

【共引文献】