發(fā)布時(shí)間：2018-02-23 06:07

  本文關(guān)鍵詞： HBV 慢性乙型肝炎 HBV DNA載量 HBsAg定量　出處：《浙江大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：因檢測(cè)方法學(xué)所限,對(duì)低病毒血癥(HBV DNA2000IU/mL)慢性乙肝患者的外周血HBV DNA載量和HBsAg水平的研究甚少。本課題旨對(duì)患者進(jìn)行精確的HBV DNA載量測(cè)定,結(jié)合HBsAg定量、年齡、性別、ALT等觀(guān)察指標(biāo)分析二者在慢性HBV感染不同階段及病程進(jìn)展和轉(zhuǎn)歸中的預(yù)測(cè)作用和臨床意義。 方法：回顧分析從2011年1月至2013年12月期間在我院就診的4087例慢性乙肝患者的臨床檢測(cè)和病例資料,其中門(mén)診3751例,住院336例,病史及HBsAg陽(yáng)性均在半年以上。對(duì)外周血HBV DNA采用Cobas AmpliPrep/Cobas TaqMan高敏核酸定量系統(tǒng)檢測(cè),HBsAg定量采用雅培的Architect HBsAg試劑盒。分析指標(biāo)主要包括HBV DNA. HBsAg. ALT.年齡、性別,從中隨機(jī)篩選符合觀(guān)察標(biāo)準(zhǔn)的1873例樣本進(jìn)行分析。結(jié)果： 1.在4087例經(jīng)治慢乙肝患者中有3553例(86.93%)為HBV DNA2,000IU/mL(含20IU/mL),有51.72%20IU/mL;在1873例有效病例中,HBeAg(-)患者占74.96%(1404例)。 2.不同HBV DNA載量組別間HBsAg水平分布差異均有統(tǒng)計(jì)學(xué)意義；相同HBVDNA載量組別內(nèi)的HBeAg(+)組與HBeAg(-)組間HBsAg水平分布差異也均有統(tǒng)計(jì)學(xué)意義。提示HBV DNA、HBsAg定量可作為獨(dú)立或聯(lián)合的抗病毒療效預(yù)測(cè)指標(biāo)。 3.對(duì)極低病毒載量(HBV DNA20IU/mL)的慢乙肝患者而言,HBsAg可能是更好的觀(guān)察和預(yù)測(cè)指標(biāo)。 4.不同HBVDNA載量組別間肝硬化、原發(fā)性肝癌發(fā)生率差異均無(wú)統(tǒng)計(jì)學(xué)意義,可能與陽(yáng)性病例較少有關(guān)。 5.采用Cobas AmpliPrep/Cobas TaqMan高靈敏度核酸定量方法有助于發(fā)現(xiàn)HBsAg(-)HBV DNA(+)的隱匿性慢性乙肝患者。 結(jié)論：采用更敏感的方法檢測(cè)HBV DNA有助于更好的了解低病毒載量慢性乙肝患者的病毒復(fù)制情況和抗病毒治療過(guò)程中病毒的清除速率,可發(fā)現(xiàn)隱匿性感染；對(duì)HBV DNA2000IU/mL的慢性乙肝患者,HBsAg水平結(jié)合HBV DNA載量可更好地預(yù)測(cè)病程的進(jìn)展和轉(zhuǎn)歸。對(duì)HBV DNA20IU/mL的慢性乙肝患者而言,HBsAg可能是更好的觀(guān)察和預(yù)測(cè)指標(biāo)。
[Abstract]:Objective: to study the HBV DNA load and HBsAg level in peripheral blood of patients with chronic hepatitis B with hypoviremia and HBV-2000 IUU / mL due to the limitation of detection methodology. The purpose of this study was to carry out accurate HBV DNA load measurement, combined with HBsAg quantification and age, in patients with chronic hepatitis B. The clinical significance of the two indexes in predicting the progression and outcome of chronic HBV infection at different stages, progression and outcome were analyzed. Methods: the clinical examination and data of 4 087 patients with chronic hepatitis B from January 2011 to December 2013 in our hospital were analyzed retrospectively. The disease history and HBsAg positive rate were more than half a year. Cobas AmpliPrep/Cobas TaqMan Gao Min nucleic acid quantitative system was used to detect HBV DNA in peripheral blood. Architect HBsAg kit was used to detect Cobas AmpliPrep/Cobas TaqMan Gao Min. The analysis indexes mainly included age and sex of HBV DNA. HBsAg Ag. alt. A total of 1873 samples that met the observation criteria were selected for analysis. Results:. 1. Among 4087 patients with chronic hepatitis B, 3 553 cases (86.93 cases) were HBV DNA2 000 IUR / mL (including 20 IUU / mLN, 51.72 IUR / mLand 74.96% of 1873 effective cases). 2. There were significant differences in the distribution of HBsAg levels among different HBV DNA load groups. There were also significant differences in the distribution of HBsAg levels between HBeAg- () and HBeAg- groups in the same HBVDNA load group, suggesting that the quantification of HBsAg could be used as an independent or combined predictor of antiviral efficacy. 3. HBsAg may be a better index for observation and prediction of chronic hepatitis B patients with very low viral load and HBV DNA 20IUmL. 4. There was no significant difference in the incidence of liver cirrhosis and primary liver cancer among different HBVDNA load groups, which might be related to the small number of positive cases. 5. Using Cobas AmpliPrep/Cobas TaqMan high sensitivity nucleic acid quantitative method is helpful to identify occult chronic hepatitis B patients with HBsAg(-)HBV DNA. Conclusion: detection of HBV DNA by a more sensitive method is helpful to better understand the viral replication in patients with chronic hepatitis B with low viral load and the rate of virus clearance during antiviral therapy, and occult infection can be found. The level of HBV combined with the load of HBV DNA in chronic hepatitis B patients with HBV DNA2000IU/mL can better predict the progression and outcome of the disease course, and it may be a better index for the observation and prediction of HBV DNA20IU/mL patients with chronic hepatitis B.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R512.62

【共引文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前2條

1 俞立飛;替比夫定治療HBeAg陽(yáng)性慢性乙型肝炎患者e抗原血清學(xué)轉(zhuǎn)換的基線(xiàn)預(yù)測(cè)因素分析[D];浙江大學(xué);2014年

2 曾林燕;浙江省慢性HBV感染者中乙型肝炎病毒表面抗原（HBsAg）水平的橫斷面研究[D];浙江大學(xué);2014年

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本文編號(hào)：1526307