目的 探讨HBeAg阴性慢性乙型肝炎患者血清HBV DNA含量与ALT的关系.方法 回顾性分析269例乙型肝炎患者的临床资料和实验室检测数据,HBeAg阴性组148例和阳性组121例,对比分析两组患者HBV DNA含量及ALT水平的关系.结果 148例HBeAg阴性乙型肝炎患者中血清HBV DNA阳性者107例(72.3%),其均值为(5.4±1.3)log10 copies·ml-1,血清ALT水平为49(129.0)IU·L-1(中位数,四分位数间距),肝硬化比例为51.4%(55/107).121例HBeAg阳性乙型肝炎患者中血清HBV DNA阳性118例(97.5%),其均值为(6.8±1.2)log10 copies·ml-1,ALT水平为105(139.5)IU·L-1(中位数,四分位数间距),肝硬化比例为13.6%(16/118).HBV DNA阳性率及含量和ALT水平HBeAg阳性组高于HBeAg阴性组(P<0.01).ALT水平在HBeAg阴性伴HBV DNA阳性组与HBeAg阳性伴HBV DNA阳性组比较无统计学意义(Z＝1.43.P＝0.15>0.05).肝硬化在HBeAg阴性伴HBV DNA阳性组所占比例最高.HBeAg阴性组较HBeAg阳性组患者的年龄较大(t＝7.046,P<0.01).结论 HBeAg阴性慢性乙型肝炎患者年龄偏大,肝硬化比例偏高,尤其是HBV DNA阳性者,肝脏炎性损伤程度与HBeAg阳性患者相似.%Objective To investigate the relationship between the level of serum HBV DNA and alanine aminotransferase( ALT) levels of patients with HBeAg-negative chronic hepatitis B. Methods All the 269 subjects(148 samples from HBeAg-negative group, 121 samples from HBeAg-posilive group) underwent the determination of HBV DNA and ALT by PCR and enzyme respectively,then its correlation was analyzed. Results HBV DNA positivity, cirrhosis, HBV DNA mean and ALT of 148 HBeAg-negative cases were 107(72. 3% ) , 51.4% (55/107), (5.4±1.3)log10copies · ml-1, and 49( 129.0) ( Median, Q)IU · L-1 respectively. HBV DNA positivity, cirrhosis, HBV DNA mean and ALT of 121 HBeAg-positive cases were 118(97.5% ), 3.6%( 16/118) , (6.8 ± 1.2)log10copies · ml-1, and 105 (139.5) (Median,Q)IU · L-1 .respectively. HBeAg-negative patients had a lower HBV DNA load and positivity,and they had more fibrotic changes in the liver than HBeAg-positive patients. The two groups did not differ in necroinflammatory activity, but the former had lower ALT value. Cirrhosis was more common in e-antigen-negative patients. Conclusion E-antigen-negative CHB patients are older and have a higher percentage of hepatic fibrosis. HBV DNA positive patients have similar necroinflammatory activity to HBeAg positive patients.
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