摘要:
Background With the development and research of clinical cure of chronic hepatitis B (CHB),testing of serum immune markers of HBV and HBV DNA load can provide reference for the clinical treatment study of CHB.Objective To analyze the serological pattern in chronic HBV-infected patients and its correlation with HBV DNA load.Methods The subjects enrolled in this study were the chronic HBV-infected outpatients and inpatients (n =2 425) who received treatment in Department of Infectious Diseases,First Affiliated Hospital of Kunming Medical University from March to December 2015.Serum immune markers and HBV DNA load were measured in the subjects by ARCHITECT i2000SR Immunoassay Analyzer with matched chemiluminescence reagent,and PGQ-PCR Amplification with HBV nucleic acid quantitative detection kit,respectively.HBsAg,HBsAb,HBeAg,HBeAb and HBcAb was labeled as 1,2,3,4,and 5,respectively.And their serological patterns were analyzed.Results Of the 7 serological patterns found in the 2 425 patients with chronic HBV infection,there were 5 patterns which occupied a proportion more than 1.00%,respectively;the patterns of " 1,3,5 1,4,5 1,3,4,5 1,5" and" 1,2,3,5" accounting for 55.05%,37.69%,3.26%,1.86% and1.53%,respectively.Therare for other patterns of " 1,2,4,5" and " 2,4,5" was 0.53% and 0.08%,respectively.The age and HBV DNA load were significant differences among the 5 main patterns (P < 0.05),but the gender was no significant differences among them (P >0.05).Notable difference in age distribution was observed among the 5 main patterns (x2 =266.625,P < 0.001).Patterns of " 1,3,5"" 1,3,4,5 1,5" and " 1,2,3,5" mainly occurred in age groups of 21-30 and 31-40,while the pattern of " 1,3,5" chiefly in age groups of 31-40 and 41-50.In chronic HBV-infected patients with pattern of " 1,3,5",the HBV DNA load was positively correlated with HBsAg and HBeAg (P < 0.05),while negatively correlated with HBcAb (P < 0.05);HBsAg was positively related to HBeAg (P < 0.05).Among chronic HBV-infected patients with pattern of " 1,4,5 1,3,4,5",the HBV DNA load was positively associated with HBeAg and HBcAb (P < 0.05).HBV DNA load was positively associated with HBsAg,HBeAg and HBcAb,HBsAg was positively associated with HBeAg in chronic HBV-infected patients with pattern of " 1,2,3,5" (P < 0.05).Conclusion There were 7 kinds of patterns in chronic HBV-infected patients with positive HBV DNA,predominated by the patterns of " 1,3,5" and " 1,4,5" Significant differences by age and HBV DNA load existed among the 5 main patterns.%背景 随着慢性乙型肝炎(CHB)临床治愈的提出及研究,乙型肝炎病毒(HBV)血清免疫标志物和HBV DNA载量检测可以为其治疗提供依据.目的 探讨慢性HBV感染者血清学模式及其与HBV DNA载量之间的关系.方法选取2015年3-12月就诊于昆明医科大学第一附属医院感染科门诊、住院的HBV DNA载量阳性的慢性HBV感染者2 425例为研究对象,采用ARCHITECT i2000SR全自动免疫发光分析仪检测HBV血清免疫标志物,采用PGQ-PCR扩增仪检测HBV DNA载量.分别以1、2、3、4、5代表乙型肝炎表面抗原(HBsAg)、乙型肝炎表面抗体(HBsAb)、乙型肝炎e抗原(HBeAg)、乙型肝炎e抗体(HBeAb)、乙型肝炎核心抗体(HBcAb),分析其血清学模式.结果 2 425例慢性HBV感染者共有7种血清学模式,所占比例>1.00%的血清学模式有5种:“1、3、5”“1、4、5”“1、3、4、5”“1、5”“1、2、3、5”模式分别占55.05%、37.69%、3.26%、1.86%、1.53%;“1、2、4、5”和“2、4、5”模式分别占0.53%和0.08%.5种主要血清学模式慢性HBV感染者年龄、HBV DNA载量比较,差异均有统计学意义(P<0.05);性别比较,差异无统计学意义(P>0.05).5种主要血清学模式慢性HBV感染者年龄构成比较,差异有统计学意义(x2=266.625,P<0.001).“1、3、5”“1、3、4、5”“1、5”“1、2、3、5”模式主要发生于21 ~ 30岁及31 ~40岁,“1、4、5”模式主要发生于31 ~40岁及41 ~50岁.“1、3、5”模式慢性HBV感染者HBV DNA载量与HBsAg、HBeAg呈正相关,与HBcAb呈负相关(P<0.05);HBsAg与HBeAg呈正相关(P<0.05).“1、4、5”“1、3、4、5”模式慢性HBV感染者HBV DNA载量与HBeAg、HBcAb呈正相关(P<0.05).“1、2、3、5”模式慢性HBV感染者HBV DNA载量与HBsAg、HBeAg、HBcAb呈正相关,HBsAg与HBeAg呈正相关(P<0.05).结论 在HBV DNA载量阳性的慢性HBV感染者中,存在7种血清学模式,以“1、3、5”和“1、4、5”模式为主,5种主要血清学模式患者年龄和HBV DNA载量均存在差异.