摘要
目的探讨乙型肝炎慢性与急性肝衰竭患者核苷（酸）类药物治疗过程中血清HBsAg定量和HBV-DNA载量的动态变化。方法51例使用核苷（酸）类药物治疗的乙型肝炎慢性与急性肝衰竭患者，检测并分析19例好转出院患者（存活组）在入院时、极期（MELD评分最高时）、康复出院时以及32例死亡患者（死亡组）人院时、临终前的血清乙型肝炎表面抗原（HBsAg）定量（电化学发光法）和HBV-DNA载量（实时荧光定量PCR）。结果血清HBsAg定量在存活组人院时、极期、康复出院时分别为（3. 63 士 0.44）、（3. 82±0. 18）,（3. 60±0. 56） log10 COI,组内两两比较，P = 0. 095-0.815;死亡组人院时和临终前分别为（3. 39±0. 66）,（3. 15±0. 79） logic COI（P =0.111）;组间比较提示存活组极期HBsAg显著高于死亡组临终前水平（P〈0. 01）； HBV-DNA载量在各个时点逐渐下降,组内比较P〈0. 01，但两组间比较，差异无统计学意义。结论乙型肝炎慢性与急性肝衰竭患者使用核苷（酸）类药物治疗，无论其转归如何，病程中血清HBV-DNA显著下降，而血清HBsAg定量没有变化，但死亡患者临终前血清HBsAg定量显著低于存活患者极期水平，可能与致死性肝坏死造成HBsAg合成下降有关。
OBJECTIVE To determine the significance and dynamic changes of serum HBsAg and HBV-DNA quan-tification in patients with acute-on-chronic hepatitis B liver failure when treated with nucles （t） ide analogues.METHODS Totally 51 patients diagnosed as acute-on-chronic hepatitis B liver failure, hospitalized in the centerfrom June 1,2009 to May 31,2010,treated with nucles（t）ide analogues, were enrolled. The serum was collectedin every 4-8 days when patients＇ liver function were tested. Meanwhile,the score of model for end-stage liver dis-cases （MELD） was calculated to determine the fatigium stage of disease course. At the end of follow-up,serumHBsAg and HBV-DNA was quantified on admission, at fastigium stage （when MELD scores were highest） andbefore discharge （after recovered） in 19 survived patients （guoup A）,and on admission, before death in 32 pa-tients （group B）. RESULTS Serum HBsAg levels on admission, at fastigium stage and before discharge in group Awere （3. 63±0. 44） , （3. 82 ±0. 18）,and （3. 60±0. 56） log10 COI,respectively （P between each time point =0. 095±0. 815）. Serum HBsAg levels on admission and before death in group B was （3. 39±0. 66） and （3. 15±0. 79） log10 COI （P = 0. 111）. The MELD score and serum HBsAg levels at fastigium stage in group A and before death in group B were significant different （both P〈0. 001）. CONCLUSION No matter patients died or survived in follow-up, serum HBsAg levels changed little during nucles （t）ide analogues therapy in patients with acute-onchronic hepatitis B liver failure （while HBV-DNA levels changed significantly）. Serum HBsAg levels before death in patients finally died was significantly lower than those fit fastigium stage in survival patients, which may be related with the reduction in expression and secretion of HBsAg caused by massive and fatal necrosis of hepatocytes.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第17期4099-4101,共3页
Chinese Journal of Nosocomiology
基金
"十二五"重大专项课题(2012ZX10004-902)
关键词
肝衰竭
终末期肝病模型
乙型肝炎表面抗原
定量
Acute-on-chronic liver failure
Model for end-stage liver diseases
HBsAg quantitation
