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  本文關(guān)鍵詞： 肝功能衰竭 肝炎 乙型 慢性 HBV-DNA 抗體 乙型肝炎病毒　出處：《天津醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討乙型肝炎相關(guān)性肝衰竭患者血清HBV-DNA低水平復(fù)制及HBV特異性抗體表達(dá)的相關(guān)因素及臨床意義,為HBV相關(guān)性肝衰竭患者評價預(yù)后提供依據(jù)。 方法：收集2008年6月至2013年12月于天津市第二人民醫(yī)院住院治療的391例乙型肝炎相關(guān)性肝衰竭患者及394例慢性乙型肝炎患者的病歷資料。1.比較乙型肝炎相關(guān)性肝衰竭與慢性乙型肝炎HBV-DNA表達(dá)的不同及影響因素分析。 2.根據(jù)HBV-Ms特異性表達(dá)的不同將肝衰竭患者分為特異性抗體陽性(指HBsAb、HBeAb和HBcAb同時陽性)和特異性抗體陰性(無HBsA、HBeAb和HBcAb同時陽性)兩組,分析2組患者HBV-DNA含量的變化和生存情況。 3.比較乙型肝炎相關(guān)性肝衰竭與慢性乙型肝炎患者及肝衰竭2組患者之間免疫功能的不同。組間比較采用獨(dú)立樣本t檢驗(yàn)或Mann-Whitney秩和檢驗(yàn),計數(shù)資料比較采用x2檢驗(yàn)。 結(jié)果：1.391例肝衰竭患者中,急性肝衰竭患者26例,亞急性肝衰竭14例,慢加急性(亞急性)肝衰竭285例,慢性肝衰竭66例。其中,慢加急性(亞急性)肝衰竭患者最多,占所有肝衰竭患者的72.89%。特異性陽性組和陰性組肝衰竭患者的類型構(gòu)成分布差異無統(tǒng)計學(xué)意義(P0.05)。 2.乙型肝炎相關(guān)性肝衰竭患者HBV-DNA水平低于慢性乙型肝炎組,差異有統(tǒng)計學(xué)意義(Z=-16.469,P0.05)；HBeAg陽性和陰性的肝衰竭患者HBV-DNA水平均低于相應(yīng)的慢性乙型肝炎患者,差異有統(tǒng)計學(xué)意義(Z分別為-11.665和-12.853,P0.05)。在391肝衰竭病例中,HBV特異性抗體陽性組29例(7.42%),死亡25例(86.21%),HBV特異性抗體陰性組362例(92.58%),死亡157例(43.37%),兩組病死率差異有統(tǒng)計學(xué)意義(P0.05)。特異性抗體陽性組患者HBV-DNA水平明顯低于特異性抗體陰性組,差異有統(tǒng)計學(xué)意義(Z=-3.594,P0.05)。2組HBeAg陰性患者HBV-DNA水平均低于HBeAg陽性患者,差異有統(tǒng)計學(xué)意義(Z分別為7.427和7.513,P0.05)。 3.與慢性乙型肝炎患者相比,肝衰竭患者免疫功能IgG、IgA、IgM及C34項(xiàng)檢測結(jié)果有顯著性差異(P0.05),其中肝衰竭組IgG、IgA、IgM明顯高于慢性乙型肝炎組和正常參考范圍,而C3則明顯低于慢性乙型肝炎組和正常參考范圍,差異有統(tǒng)計學(xué)意義,其中HBV特異性抗體陽性組與HBV特異性抗體陰性組相比在IgG、IgA、IgM檢測指標(biāo)上差異無統(tǒng)計學(xué)意義(P0.05),而C3結(jié)果低于HBV特異性抗體陰性組,差異有統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：HBV-Ms表達(dá)形式及機(jī)體免疫狀態(tài)的動態(tài)變化在乙型肝炎相關(guān)性肝衰竭的發(fā)生發(fā)展過程中起著一定作用,HBV-DNA低水平復(fù)制系機(jī)體處于免疫清除期所致,而同時伴抗-HBs、抗-HBe、抗-HBc三個抗體同時陽性則提示機(jī)體對乙型肝炎病毒的超強(qiáng)免疫反應(yīng),致使病情惡化、發(fā)展迅速,病死率高。因此,加強(qiáng)健康教育、督促患者定期復(fù)查對于肝衰竭患者的防治十分重要。
[Abstract]:Objective: to investigate the clinical significance of the low level replication of serum HBV-DNA and the expression of HBV specific antibody in patients with hepatitis B associated liver failure. To provide a basis for evaluating the prognosis of patients with HBV associated liver failure. Methods:. The medical records of 391 patients with hepatitis B related liver failure and 394 patients with chronic hepatitis B were collected from June 2008 to December 2013 in Tianjin second people's Hospital. To compare the difference of HBV-DNA expression between hepatitis B associated liver failure and chronic hepatitis B and the analysis of influencing factors. 2. According to the specific expression of HBV-Ms, the patients with liver failure were divided into specific antibody positive (HBsAb). Both HBeAb and HBcAb were positive and the specific antibody was negative (no HBsAg HBeAb and HBcAb were positive). The changes of HBV-DNA content and survival in two groups were analyzed. 3. To compare the difference of immune function between hepatitis B associated liver failure patients and chronic hepatitis B patients and liver failure patients. Independent sample t test or Mann-Whitney rank sum were used in the comparison between groups. Test. The count data were compared by x 2 test. Results among the 391 cases of liver failure, 26 were acute hepatic failure, 14 subacute liver failure, 285 slow plus acute liver failure and 66 chronic liver failure. Patients with chronic and acute (subacute) liver failure were the most. 72.89% of all patients with liver failure. There was no significant difference in the distribution of type composition between the specific positive group and the negative group. 2.The level of HBV-DNA in patients with hepatitis B associated liver failure was lower than that in patients with chronic hepatitis B, and the difference was statistically significant (P 0.05). The levels of HBV-DNA in HBeAg positive and negative liver failure patients were lower than those in corresponding chronic hepatitis B patients, the difference being -11.665 and -12.853 respectively. In 391 cases of liver failure, 29 cases were positive for HBV specific antibody, and 25 cases died (86.21%). In the HBV specific antibody negative group, 362 cases (92. 58%) and 157 cases died (43. 37%). There was a significant difference in mortality between the two groups (P 0.05). The level of HBV-DNA in the positive group was significantly lower than that in the negative group. The level of HBV-DNA in HBeAg negative group was lower than that in HBeAg positive group. The differences were 7.427 and 7.513 (P 0.05), respectively. 3.Compared with the patients with chronic hepatitis B, the immunological function of patients with liver failure was significantly higher than that of patients with chronic hepatitis B (P 0.05). IgA IgM was significantly higher than chronic hepatitis B group and normal reference range, while C3 was significantly lower than chronic hepatitis B group and normal reference range, the difference was statistically significant. The HBV specific antibody positive group and the HBV specific antibody negative group had no significant difference in the IgG specific antibody detection index (P0.05). But the C 3 result was lower than that of HBV specific antibody negative group, the difference was statistically significant (P 0.05). Conclusion the expression of HBV-Ms and the dynamic changes of immune state play an important role in the occurrence and development of hepatitis B related liver failure. The low level replication of HBV-DNA is caused by immune clearance, and it is accompanied by anti-HBs and anti-HBe. Anti-HBc antibody positive at the same time indicates that the body to hepatitis B virus super-strong immune response, leading to the deterioration of the disease, rapid development, high mortality. Therefore, strengthen health education. It is very important to urge patients to review regularly for the prevention and treatment of liver failure.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.62;R575.3

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