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目的分析乙型肝炎e抗原(HBeAg)阴性与HBeAg阳性慢性重型乙型肝炎患者的临床特点。方法2001年1月至2006年9月在重庆医科大学附属二医院收治的353例慢性重型乙型肝炎患者分为HBeAg阴性组236例(66.8%),HBeAg阳性组117例(33.2%),HBeAg阴性患者平均年龄高于HBeAg阳性患者,分别为(43.5±12.4)岁和(40.8±11.3)岁,两组比较差异有统计学意义(t=-1.988,P=0.048)。对两组生化指标、HBV DNA、肝硬化基础、并发症、预后等进行分析。结果HBeAg阴性患者血清HBV DNA低于HBeAg阳性患者,分别为(5.49±2.02)log10拷贝/mL、(6.64±1.41)log10拷贝/mL,两组比较差异有统计学意义(t=6.46,P<0.001);且HBeAg阴性患者血清HBV DNA<5 log10拷贝/mL的病例数比例为41.8%,远高于HBeAg阳性患者(11.9%),两组比较差异有统计学意义(χ2=30.055,P<0.001)。两组在肝脏生化指标、肝硬化基础及发生感染、腹水、肝性脑病、消化道出血等并发症及近期预后方面比较,差异均无统计学意义。结论HBeAg阴性患者血清HBV DNA低于HBeAg阳性患者。HBeAg阴性慢性重型肝炎的肝脏生化指标、并发症发生率及近期预后与HBeAg阳性的慢性重型肝炎相似。应重视低水平病毒复制的HBeAg阴性慢性乙型肝炎患者的治疗、随访,早期抗病毒治疗,减少重型肝炎的发生率。
Objective To analyze the clinical features of hepatitis B e antigen (HBeAg) negative and HBeAg positive chronic severe hepatitis B patients. Methods From January 2001 to September 2006, 353 patients with chronic severe hepatitis B admitted to the Second Affiliated Hospital of Chongqing Medical University were divided into two groups: 236 cases (66.8%) with HBeAg negative group, 117 cases (33.2%) with HBeAg positive group, HBeAg The average age of negative patients was higher than that of HBeAg positive patients (43.5 ± 12.4) and (40.8 ± 11.3) years, respectively. The difference between the two groups was statistically significant (t = -1.988, P = 0.048). Two groups of biochemical indicators, HBV DNA, the basis of liver cirrhosis, complications, prognosis were analyzed. Results The serum HBV DNA of HBeAg-negative patients was lower than that of HBeAg-positive patients (5.49 ± 2.02) log10 copies / mL and (6.64 ± 1.41) log10 copies / mL respectively, with significant difference between the two groups (t = 6.46, P < 0.001). The proportion of HBeAg-negative patients with serum HBV DNA <5 log10 copies / mL was 41.8%, much higher than that of HBeAg-positive patients (11.9%). There was significant difference between the two groups (χ2 = 30.055, P < 0.001). There was no significant difference between the two groups in biochemical indicators of liver, cirrhosis and infection, ascites, hepatic encephalopathy, complications of gastrointestinal bleeding and recent prognosis. Conclusions Serum HBV DNA in HBeAg-negative patients is lower than in HBeAg-positive patients. HBeAg-negative chronic hepatitis B liver biochemical indicators, the incidence of complications and the recent prognosis and HBeAg-positive chronic severe hepatitis similar. Should pay attention to low-level virus replication in patients with HBeAg-negative chronic hepatitis B treatment, follow-up, early anti-viral treatment, reduce the incidence of severe hepatitis.