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目的研究慢性乙型肝炎(乙肝)病例(Chronic Hepatitis B Patient,CHBP)乙肝病毒(Hepatitis B Virus,HBV)复制、乙肝病毒e抗原(HBV e Antigen,HBeAg)状态与丙氨酸氨基转移酶(Alanine Aminotransferase,ALT)检测值之间的相关关系。方法对31个省(自治区、直辖市)发现的确诊CHBP采血,检测肝功能和HBV感染血清学标志物[乙肝病毒表面抗原(HBV Surface Antigen,HBsAg)、HBeAg]及乙肝病毒脱氧核糖核酸(HBV Deoxyribonucleic Acid,DNA)载量。ALT指标在采血24h内由当地医疗机构检测。HBsAg、HBeAg及HBV DNA载量检测由中国疾病预防控制中心病毒病预防控制所统一完成。HBsAg、HBeAg使用美国雅培(Abbott)试剂光化学发光微粒子免疫分析法(Chemiluminesent Microparticle Immunoassay,CMIA)检测。HBV DNA载量使用实时聚合酶链反应(Polymerase Chain Reaction,PCR)工具包(中国复星医药有限公司)检测。结果 <20岁、20~40岁和>40岁CHBP中,高病毒载量[HBV DNA>105拷贝/毫升(Copies/ml)]者比例分别为70.21%、40.37%和28.75%(χ2=29.38,P<0.001)。在HBV DNA低(<103Copies/ml)、中(103~105Copies/ml)、高(>105Copies/ml)载量组内,HBeAg阳性率分别为2.36%、9.40%和82.24%,两两差异均有统计学意义(χ2=5.57,P=0.02;χ2=177.78,P<0.001;χ2=140.31,P<0.001)。多因素分析结果显示,影响CHBP ALT的独立因素有年龄、性别和HBV DNA载量。相对于0~19岁CHBP,20~39岁CHBP ALT升高比值比(Odds Rate,OR)=3.27[95%可信区间(Confidence Interval,CI):1.32~8.01],>40岁CHBP ALT升高OR=3.92(95%CI:1.54~9.98)。相对于女性,男性CHBP ALT升高OR=2.93(95%CI:1.64~5.24)。中病毒载量和低病毒载量对CHBP ALT的影响差异无统计学意义(χ2=0.20,P=0.66),但高病毒载量组ALT升高的OR=3.01(95%CI:1.33~6.80)。结论 HBeAg阳性CHBP体内HBV复制活跃,HBV DNA高病毒载量是CHBP ALT升高的危险因素。
Objective To investigate the relationship between hepatitis B virus (HBV) e antigen (HBeAg) status and Alanine aminotransferase (CHB) in Chronic Hepatitis B Patient (CHBP) Aminotransferase, ALT) detection of the correlation between. Methods Serum markers of liver function and hepatitis B virus infection (HBV Surface Antigen, HBeAg, HBeAg) and HBV Deoxyribonucleic Acid (HBV) were detected in 31 CHB patients (autonomous regions and municipalities directly under the Central Government) Acid, DNA) load. ALT indicators within 24 hours of blood testing by the local medical institutions. HBsAg, HBeAg and HBV DNA load testing by the Chinese Center for Disease Control and Prevention viral disease prevention and control of a unified. HBsAg and HBeAg were detected by using Abbott Chemiluminesent Microparticle Immunoassay (CMIA). HBV DNA load was detected using the Polymerase Chain Reaction (PCR) kit (China Fosun Pharma Co., Ltd.). Results The proportions of high viral load [HBV DNA> 105 copies / ml] were 70.21%, 40.37% and 28.75% (χ2 = 29.38, respectively) in CHBP <20 years, 20-40 years and> 40 years , P <0.001). The positive rates of HBeAg were 2.36%, 9.40% and 82.24% respectively in HBV DNA low (<103Copies / ml), medium (103-105Copies / ml) and high (> 105Copies / ml) There was statistical significance (χ2 = 5.57, P = 0.02; χ2 = 177.78, P <0.001; χ2 = 140.31, P <0.001). Multivariate analysis showed that independent factors affecting CHBP ALT were age, gender and HBV DNA load. Relative odds ratio (odds ratio, OR) = 3.27 [95% confidence interval (CI): 1.32 to 8.01), CHBP ALT rise> 40 years High OR = 3.92 (95% CI: 1.54-9.98). Relative to women, men with CHBP ALT increased OR = 2.93 (95% CI: 1.64 ~ 5.24). There was no significant difference in CHBP ALT between viral load and low viral load (χ2 = 0.20, P = 0.66), but the OR of high ALT was 3.01 (95% CI: 1.33-6.80) ). Conclusion HBeAg-positive CHBP in vivo HBV replication is active, high HBV DNA viral load is a risk factor for elevated CHBP ALT.