目的对广州市慢性乙型肝炎患者不同感染阶段表面抗原(HBsAg)水平进行定量检测,并结合乙型肝炎病毒DNA(HBVDNA)等检测结果探讨HBsAg定量在慢性乙型肝炎患者诊断和治疗监测的临床意义。方法按照美国肝病学会慢性乙型肝炎分期规则标准将其分为免疫耐受期(IT)、e抗原阳性的慢性肝炎期(EPH)、非活动性携带期(IC)、e抗原阴性的慢性乙型肝炎期(ENH)。将珠江医院就诊的慢性乙型肝炎患者96例按要求分期,对其血清样本进行HBsAg、HBV-DNA和ALT检测,并对结果进行统计分析。结果广州市慢性乙型肝炎感染过程不同阶段HBsAg均值分别为:IT(4.12 log10U/L)、EPH(4.02 log10U/L)、IC(2.85 log10U/L)、ENH(3.29 log10U/L),差异显著。IT、IC、EPH、ENH期患者HBsAg水平与HBV-DNA拷贝数的相关系数分别是0.6828、0.5759、0.3280、0.1083,相关性逐步减弱。HBeAg(+)患者HBsAg定量水平明显高于HBeAg(-)患者。各期HBsAg的量与ALT水平均无相关性。结论不同感染阶段的慢性乙型肝炎患者HBsAg定量水平存在差异,HBsAg水平与HBV-DNA的不完全一致性表明HBsAg定量可以作为新的检测指标在诊断和治疗监测中发挥作用,更多的检测手段将有助于临床慢性乙型肝炎患者的个体化分类和治疗。

Objective To assess the value of quantitative analysis of hepatitis B surface antigen (HBsAg) levels in the diagnosis and therapeutic evaluations in patients with chronic hepatitis B (CHB). Methods According to the staging criteria defined by the American Association of Liver Diseases, 96 patients with CHB admitted in Zhujiang Hospital were classified in immune-tolerant (IT), HBeAg-positive hepatitis (EPH), inactive carrier (IC) and HBeAg-negative hepatitis (ENH) phases. Serum HBsAg, HBV-DNA and ALT levels were quantified and their correlations were evaluated in each phase of infection. Results The mean HBsAg titers (measured in log10U/L) differed significantly between the phases of CHB (4.12 in IT, 4.02 in EPH, 2.85 in EPH, and 3.29 in ENH). The correlation coefficient of HBsAg with HBV-DNA was 0.6828 in IT, 0.5759 in EPH, 0.3280 in IC, and 0.1083 in ENH. Serum HBsAg titers were significantly higher in HBeAg-positive patients than in HBeAg-negative patients. No correlation was found b

目的：研究感染乙型肝炎病毒患者的乙型肝炎病毒 e 抗原（HBeAg）转阴与长期应用拉米夫定诱发的YMDD 变异和病毒基因型的相关性。方法选取本院确诊的慢性乙型肝炎患者1200例，其中 HBeAg 血清学转阴患者577例，未转阴患者623例，检测患者 HBeAg 、乙型肝炎病毒脱氧核糖核酸（HBV-DNA ）和 HBV 基因型，并比较和探讨3者的关系。结果577例 HBeAg 阴性患者中有233例（40．38％）存在病毒复制（HBV-DNA ≥103）；对233例基因分型显示，A 、B 、C 、D 基因型分别为163例（69．96％）、57例（24．46％）、11例（4．72％）、2例（0．86％）；YMDD 突变检测发现，233例患者中106例（45．49％）发生 YMDD 突变，其中Ⅴ突变68．87％，Ⅰ突变22．64％，Ⅰ/Ⅴ共生突变8．49％。在106例 YMDD 突变患者中 A 、B 、C 、D 基因型分别为0例（0．00％）、72例（67．92％），27例（25．47％），7例（6．60％）。结论本院所在地区 HBeAg 血清转阴的慢性乙型肝炎患者病毒复制仍保持一定的活力，持续监测病毒拷贝数、YMDD 突变和基因型对于此类患者治疗非常必要。

Objective To study the correlation between hepatitis B e antigen (HBeAg)-negative and HBV gen-otype ,YMDD mutation induced by long-term use of lamivudine in patients with hepatitis B virus infection .Methods 1 200 patients with chronic hepatitis B were recruited in this study ,of which 577 patients were HBeAg negative and 623 were HBeAg positive .Enzyme-linked immunoadsordent assay(ELISA) ,Taqman QPCR and linear probe hybrid-ization were used to detect HBeAg 、HBV-DNA and HBV genotypes respectively .And the relationships between them were analyzed .Results There were 233 patients(40 .38% )with HBV-DNA virus replication (HBV-DNA ≥ 103 ) in all the 577 HBeAg-negetive patients .Further genotyping results showed that there were 163 (69 .96% ) ,57 (24 .46% ) ,11(4 .72% ) and 2(0 .86% ) cases in genotype A ,B ,C and D respectively .YMDD mutation test found that there was 106 cases in 233 patients(45 .49% )with YMDD mutation ,composed by Ⅴ mutation(68 .87% ) ,Ⅰ muta-tions(22 .64%

目的探讨抗病毒治疗对乙型肝炎e抗原(HBeAg)阴性慢性乙型肝炎(CHB)患者外周血T淋巴细胞亚群状态的影响。方法选择重庆市垫江县人民医院就诊的70例HBeAg阴性CHB患者为试验组,采用流式细胞技术检测研究对象外周血CD4+、CD8+T淋巴细胞的表达情况,并在抗病毒治疗24周后,再次检测CD4+、CD8+T淋巴细胞、HBV-DNA的表达及肝功能变化情况。并与同期门诊正常体检健康者35例(对照组)检测结果作对照研究。结果实验组CD4+T淋巴细胞较对照组降低,而CD8+则相对较高,差异有统计学意义(P0.05);拉米夫定抗病毒治疗24周后,丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、HBV-DNA等指标均有明显降低,临床症状改善,同时CD4+T淋巴细胞表达较前明显提高(P0.05)。结论 T淋巴细胞亚群在HBeAg阴性CHB患者发病及转归中起重要作用,抗病毒治疗能够提高外周血T淋巴细胞亚群的水平,增强患者的抗病毒能力。

Objective To investigate the variation of T lymphocyte subsets in peripheral blood of patients with HBeAg-negative chronic hepatitis B after the treatment of Lamivudine .Methods Folw cytometry was used to detect the CD4+ ,CD8+ T cell ,liver function and HBV-DNA in 70 patients with HBeAg-negative chronic hepatitis B .These indicators were detected again after 24 weeks therapy of Lamivudine .Results The percentage of CD4+ T cell was lower ,but higher in CD8+ T cells ,and both had statistical differences compared with controls (P<0 .05) .After the antiviral therapy by Lamivudine for 24 weeks ,the expression of HBV-DNA ,ALT and AST significantly degraded and the clinical symptoms also improved ,furthermore the expression of CD4+ T cell obviously increased(P<0 .05) .Con-clusion T-lymphocyte palyed extremely important role in the course of disease with HBeAg-negative chronic hepati-tis B patients and anti-hepatitis B virus treatment could enhance cellular immunity of the patients ,and improv

目的：探讨聚乙二醇干扰素α-2a（简称α-2a）在≥60岁老年乙型肝炎患者中抗病毒治疗的有效性和安全性。方法选取2009年4月至2013年4月武汉市医疗救治中心收治的62例老年慢性乙型病毒性肝炎患者为老年组，同期65例非老年患者为对照组。两组均接受α-2a 180μg，皮下注射，每周1次，治疗48周。结果老年人乙肝e抗原（HBeAg）阳性和HBeAg阴性组早期病毒学应答（4%，5.4%）低于对照组（25.92%，21.05%），HBeAg阳性患者持续病毒学应答（28.00%）低于对照组（55.56%），差异有统计学意义（P＜0.05）。老年组HBeAg转阴率[8（32.00%）]与对照组HBeAg转阴率[9（33.33%）]相比，差异无统计学意义（P＞0.05）。抑郁、心电图改变、白细胞计数下降不良反应发生率高于对照组（P＜0.05）。结论α-2a能够抑制HBeAg阳性和HBeAg阴性的老年乙肝患者体内乙肝病毒（HBV）-DNA复制，且能致HBeAg阳性患者血清学转阴。对于HBeAg阴性老年患者更易获得持续病毒学应答。治疗同时密切关注不良反应，及时干预。

ObjectiveTo evaluate the efficacy and safety ofpeginterferon alpha-2a (α-2a) for the elderly patients with chronic hepatitis B (CHB).Methods A total of 62 elderly CHB patients (age>60 years) admitted in Wuhan Medical Treatment Center from April 2009 to April 2013 were recruited in this study and assigned into the elderly group. Another 65 CHB patients (age 0.05). The incidence of main adverse effects, such as depression, ECG abnormalities and leucopenia, were significantly higher in the elderly group than in the control group (P<0.05).Conclusionα-2a suppresses the replication of hepatitis B virus DNA, and results in HBeAg seroconversion in HBeAg-positive and -negative elderlyCHB patients. It is more likely to achieve SVR to HBeAg-negative elderly patients. During the treatment, close attention should be paid to adverse reactions and timely intervention is necessary.

目的 观察国产恩替卡韦治疗慢性乙型肝炎的临床疗效并评估影响疗效的因素.方法 应用国产恩替卡韦治疗浙江省绍兴市第六人民医院2010年12月至2012年12月门诊或住院200例慢性乙型肝炎患者,分别于12、24、48周进行病毒学、血清学及生化学指标的检测,并将包括乙型肝炎e抗原(HBeAg)阳性或阴性、基线丙氨酸转氨酶(ALT)水平、乙型肝炎病毒脱氧核糖核酸(HBV DNA)转阴时间、基线HBV DNA水平及肝组织病理特征等因素对疗效的影响进行评估.结果 国产恩替卡韦治疗48周,ALT复常率为78.5％ (157/200),HBV DNA转阴率为84.5％(169/200),HBeAg血清转换率23.4％(33/141,耐药率为0％;基线ALT ＞5倍正常值上限(ULN)患者的HBeAg血清学转换率高于2～5 ULN的患者[分别为35.4％ (19/54)和16.1％(14/87),P＜0.05];治疗24周后HBV DNA阴转的患者与未阴转的患者相比,其48周HBV DNA阴转、ALT复常和HBeAg血清学转换的比例明显增高[分别为92.4％(134/145)、86.2％(125/145)、20.7％ (30/145)和63.6％ (35/55)、58.2％(32/55)、5.5％(3/55),均P＜0.05];炎症活动分级(G)＞2,HBeAg血清转换率高于G≤2[分别为37.5％(12/32)和15.0％(3/20),P＜0.05];基线病毒载量高低与48周疗效差异无统计学意义(P＞0.05).在治疗48周过程中8例发生一过性ALT升高,无患者因发生不良事件而停药.结论 国产恩替卡韦能明显抑制HBV DNA复制,促进ALT复常及HBeAg血清转换,有效改善肝功能,耐药率低,安全性良好.且基线ALT＞5 ULN、炎症活动分级G＞2及治疗24周后HBV DNA阴转的患者在48周时有更好的疗效.

Objective To investigate the effect of domestic entecavir on chronic hepatitis B.Methods The virology,serology and biochemical indicators of 200 patients who received entecavir for the treatment of chronic hepatitis B were analyzed before treatment and 12,24 and 48 weeks after treatment.Results After 48 weeks of treatment,hepatitis B virus(HBV) DNA negative rate was 84.5％ (169/200) ; hepatitis B e antigen(HBeAg) seroconversion rate was 23.4％ (33/141) ; alanime transaminase (ALT) normolization rate was 78.5％ (157/200)and drug resistant rate was 0.The rate of HBeAg seroconversion in patients with baseline ALT ＞ 5 ULN was significantly higher than tht in patients with 2 to 5 ULN[35.4％ (19/54) vs 16.1％ (14/87),P ＜0.05].Compared with patients with no HBV DNA negative conversion at 24 weeks,ratio of HBV DNA negative conversion,ALT normalization and HBeAg seroconversion were significantly higher in patients with HBV DNA negative 48 weeks after treatment [92.4％ (134/145) vs 6