本文選題：HBsAg自然轉(zhuǎn)陰　切入點(diǎn)：乙肝血清標(biāo)志物　出處：《延安大學(xué)》2017年碩士論文

【摘要】：【目的】探索乙型肝炎病毒表面抗原(Hepatitis B surface antigen,HBsAg)自發(fā)性血清清除的慢性乙型肝炎病毒(Hepatitis B virus,HBV)感染者的臨床特點(diǎn)。包括表面抗原定量數(shù)值與其陰轉(zhuǎn)的關(guān)系;不同年齡、性別的患者在發(fā)生HBsAg自然陰轉(zhuǎn)過(guò)程中是否存在顯著性差異;同時(shí)明確此過(guò)程的影響因素,包括促進(jìn)HBsAg陰轉(zhuǎn)和阻礙HBsAg陰轉(zhuǎn)的相關(guān)因素,比如家族史、飲酒史、性別、年齡是否會(huì)對(duì)這一進(jìn)程產(chǎn)生正性或負(fù)性作用;并對(duì)HBsAg轉(zhuǎn)陰的患者進(jìn)行隨訪,評(píng)估其預(yù)后�！痉椒ā考{入85例HBsAg自發(fā)清除的慢性HBV感染者,這些患者來(lái)源于延大附院感染科病房及門診,就診時(shí)間為2014年9月—2017年2月。慢性乙型肝炎(Chronic hepatitis B,CHB)診斷依據(jù)我國(guó)慢乙肝防治指南2015年版標(biāo)準(zhǔn),除外藥物治療導(dǎo)致的HBsAg轉(zhuǎn)陰病例(干擾素或核苷類藥物)。并設(shè)置對(duì)照組,收集患者的一般資料,包括年齡、性別、乙肝家聚史、飲酒史,回顧性收集患者既往乙型肝炎病毒標(biāo)志物(Hepatitis B virus Markers,HBV M),包括HBsAg,乙型肝炎病毒表面抗體(Hepatitis B surface antibody,HBsAb),乙型肝炎病毒e抗原(Hepatitis B e antigen,HBeAg),乙型肝炎病毒e抗體(Hepatitis B e antibody,HBeAb),乙型肝炎病毒核心抗體(Hepatitis B core antibody,HBcAb)、乙型肝炎病毒脫氧核糖核酸(Hepatitis B virus deoxyribonucleic acid,HBV DNA)定量、腹部B超、肝功、甲胎蛋白(Alpha-fetoprotein,AFP)、肝纖維化指標(biāo)、肝纖維化無(wú)創(chuàng)檢測(cè)值,肝癌患者收集其上腹部增強(qiáng)核磁共振。并對(duì)其進(jìn)行隨訪,隨訪內(nèi)容包括患者以上各指標(biāo)的變化。隨訪終點(diǎn)為啟動(dòng)抗病毒治療、患者因病情進(jìn)展死亡及隨訪時(shí)間截止2017年2月。應(yīng)用相應(yīng)的統(tǒng)計(jì)學(xué)方法進(jìn)行分析處理�！窘Y(jié)果】1.隨訪時(shí)間為2-42年,隨訪時(shí)間平均值(17.5±9.5)年。hbsag轉(zhuǎn)陰時(shí)間(14.6±9.6)年,3例病人hbv基因分型為c型,3例病人啟動(dòng)抗病毒治療。2.85例hbsag自然轉(zhuǎn)陰的慢性hbv感染者中男性57例(67.1%),女性28例(32.9%)。年齡21-73歲,平均年齡(47.7±12.1)歲。3.hbsag轉(zhuǎn)陰后復(fù)現(xiàn)患者3例(3.5%),均為男性。在隨訪時(shí)間內(nèi),其中hbsag復(fù)現(xiàn)后再未消失者1例(1.2%),hbsag復(fù)現(xiàn)后轉(zhuǎn)陰者2例(2.3%)。男性復(fù)發(fā)與女性復(fù)發(fā)率fisher精確概率法p值0.05。4.85例hbsag自然轉(zhuǎn)陰的慢性hbv感染者中隨訪起始hbeag陽(yáng)性者6例(7.0%),hbeag陰性者65例(76.5%)。情況不詳者14例(16.5%)。5.hbsag轉(zhuǎn)陰時(shí)hshbvdna(highsensitivehbvdna)定量:0-197iu/ml。6.hbsab的值與谷丙轉(zhuǎn)氨酶(alanineaminotransferance,alt)相關(guān)性分析r=-0.013,p=0.894。hbsab的值與(aspartateaminotransferase,ast)相關(guān)性分析:r=-0.075,p=0.712。7.hbcab的值與alt相關(guān)性分析:r=0.190,p=0.072。hbcab的值與ast相關(guān)性分析:r=-0.008,p=0.955。8.hbcab與hbsag相關(guān)性分析,r=-0.559,p=0.000。9.hbsag轉(zhuǎn)陰時(shí)年齡≤50歲,共56例:上腹部b超、肝功正常者49例,肝硬化(livercirrhosis,lc)者7例,肝癌(hepatocellularcarcinoma,hcc)者0例。hbsag轉(zhuǎn)陰時(shí)年齡50歲,共29例:9例患者腹部b超、肝功正常,16例出現(xiàn)肝硬化,4例患者發(fā)生hcc。χ2=29.509,p=0.000。≤50歲平均肝纖維化無(wú)創(chuàng)檢測(cè)值6.3kpa,50歲9.9kpa,經(jīng)t檢驗(yàn),p=0.003,差異具有統(tǒng)計(jì)學(xué)差異。10.對(duì)照組為hbsag未轉(zhuǎn)陰的慢性hbv感染者80例,性別、家族史、飲酒史年齡的多分類logistic回歸分析,其p值分別為:0.645、0.514、0.440、0.002。11.隨訪初期hbsag的均值:(75.93±12.40)iu/ml,95%置信區(qū)間(50.98,100.98)iu/ml。hbcab的均值:(173.8±22.6)s/co,95%置信區(qū)間(128.94,218.72)iu/ml。12.afp和肝纖四項(xiàng)中的層連蛋白(laminin,ln)的pearson相關(guān)系數(shù)為0.787,P=0.000。【結(jié)論】1.HBsAg自然陰轉(zhuǎn)者中,男性所占百分比較多。2.HBsAg自然陰轉(zhuǎn)后,仍然會(huì)有部分患者乙肝表面抗原再現(xiàn),但其再現(xiàn)與患者性別無(wú)相關(guān)性。3.HBeAg陰性者較HBeAg陽(yáng)性者出現(xiàn)HBsAg自然陰轉(zhuǎn)的可能性大。4.HBsAg轉(zhuǎn)陰時(shí),血清中仍可測(cè)到HBV DNA,即乙肝表面抗原陰性,不能排除HBV感染。5.HBsAb的值與ALT、AST無(wú)相關(guān)性,提示HBsAb升高,不會(huì)預(yù)示肝功損傷;HBcAb的值與ALT、AST無(wú)相關(guān)性,提示HBcAb升高,不會(huì)預(yù)示肝功損傷。6.HBcAb與HBsAg呈負(fù)相關(guān),前者升高,提示后者血清學(xué)清除的可能性。7.與50歲以后出現(xiàn)HBsAg自發(fā)清除患者比較,50歲以前即發(fā)生轉(zhuǎn)陰者出現(xiàn)肝硬化、HCC的幾率小。8.性別、家族史、飲酒史不是促進(jìn)HBsAg轉(zhuǎn)陰的因素,而對(duì)于乙肝表面抗原100IU/ml以下的患者,隨著年齡增長(zhǎng),HBsAg轉(zhuǎn)陰的可能性增大。9.AFP和肝纖四項(xiàng)中的LN具有相關(guān)性,AFP升高,LN會(huì)隨著升高,兩者具有相關(guān)性。
[Abstract]:[Objective] to explore the hepatitis B virus surface antigen (Hepatitis B surface antigen, HBsAg) spontaneous seroclearance in chronic hepatitis B virus (Hepatitis B, virus, HBV) the clinical features of infection. Including the relationship with negative quantitative surface antigen; different age, sex occurred in patients with HBsAg negative natural existence significant differences in the process; influence factors and define this process, including the promotion of related factors of HBsAg negative and HBsAg negative obstacles, such as family history, drinking history, gender, age, whether it will have a positive or negative role in this process; and the HBsAg negative patients were followed up to evaluate the prognosis [Methods]. Infection in 85 patients with spontaneous clearance of HBsAg in chronic HBV, these patients from Yanan University Affiliated Hospital infection wards and outpatient visits, time is September 2014 to February 2017. Chronic hepatitis B (Chron IC hepatitis B, CHB) on the basis of our diagnosis of chronic hepatitis B prevention and treatment guidelines in 2015 version of the standard, except the drug treatment resulted in HBsAg negative cases (interferon or nucleoside drugs). Control group was set, data were collected including age, gender, family history of hepatitis B, drinking history, history of hepatitis B patients were retrospectively collected. Hepatitis B virus markers (Hepatitis B, virus Markers, HBV M), including HBsAg, hepatitis B virus surface antibody (Hepatitis B surface antibody, HBsAb), hepatitis B virus e antigen (Hepatitis B e antigen, HBeAg), hepatitis B virus e antibody (Hepatitis B e antibody, HBeAb), hepatitis B virus core antibody (Hepatitis B core antibody, HBcAb), hepatitis B virus deoxyribonucleic acid (Hepatitis B virus deoxyribonucleic acid, HBV DNA) quantitative abdominal ultrasound, liver function, alpha fetoprotein (Alpha-fetoprotein, AFP), liver fibrosis index, Noninvasive detection of liver fibrosis in patients with hepatocellular carcinoma were collected on the value of enhanced abdominal MRI. The changes were followed up, the follow-up including the indexes above. End point for follow-up commencement of antiviral therapy, the patients died because of disease progression and follow-up time as of February 2017. By using relevant statistical methods were analyzed. [results] 1. follow-up of 2-42 years, the average follow-up time (17.5 + 9.5).Hbsag clearance time (14.6 + 9.6) years, 3 cases of HBV gene in patients with type C, 3 cases of patients starting antiretroviral therapy for.2.85 patients HBsAg negative chronic HBV infection in 57 cases of male, female 28 (67.1%) cases (32.9%). The age is 21-73 years old, the average age (47.7 + 12.1) of 3 cases of recurrent patients after.3.hbsag negative (3.5%), were male. During the follow-up period, of which HBsAg reappearance hasn't disappeared in 1 cases (1.2%), 2 cases of recurrence after HBsAg were negative (2.3%) male. Recurrent and the recurrence rate of female Fisher exact probability p 0.05.4.85 cases but HBsAg of chronic HBV infection in the follow-up of the initial HBeAg were positive in 6 cases (7%), 65 HBeAg negative patients (76.5%). 14 cases were unknown (16.5%).5.hbsag negative hshbvdna (highsensitivehbvdna): quantitative transaminase 0-197iu/ml.6.hbsab value with alanine (alanineaminotransferance, ALT). The correlation between r=-0.013, p=0.894.hbsab (aspartateaminotransferase, AST) and the value of correlation analysis: r=-0.075, p=0.712.7.hbcab value and ALT correlation analysis: r=0.190, AST and p=0.072.hbcab correlation value analysis: r=-0.008, p=0.955.8.hbcab and HBsAg correlation analysis, r=-0.559, p=0.000.9.hbsag negative aged less than 50 years. A total of 56 cases of upper abdominal B Ultrasound, 49 cases of normal liver function, liver cirrhosis (livercirrhosis, LC) in 7 cases of hepatocellular carcinoma (hepatocellularcarcinoma, HCC) in 0 cases of.Hbsag negative Age of 50 years, a total of 29 cases: 9 cases of patients with abdominal B Ultrasound, normal liver function, 16 cases of liver cirrhosis, 4 cases of patients with hcc. x 2=29.509, p=0.000. = 50 years average liver fibrosis non-invasive detection value of 6.3kpa, the 50 year old 9.9kpa, by t test, p=0.003, the difference is statistically significant in 80 cases,.10. infection in control group HBsAg non negative chronic HBV gender, family history, drinking history age classification logistic regression analysis, the P values were: mean HBsAg 0.645,0.514,0.440,0.002.11. early follow-up: (75.93 + 12.40) iu/ml, 95% confidence interval (50.98100.98): iu/ ml.hbcab (mean 173.8 + 22.6) s/co, 95% confidence interval (128.94218.72) iu/ml.12.afp and hepatic fibrosis four in laminin (laminin, LN) Pearson correlation coefficient is 0.787. [Conclusion] P=0.000. 1.HBsAg spontaneous negative-conversicn in male, the percentage is.2.HBsAg natural seroconversion, there will still be a part of patients with hepatitis B The surface antigen of reproduction, but its reproduction no correlation between.3.HBeAg negative and HBeAg positive patients were sex HBsAg spontaneous negative-conversicn likely.4.HBsAg negative, can still be detected HBV DNA in serum, the HBsAg negative value and ALT.5.HBsAb cannot exclude HBV infection, AST had no correlation, suggesting that HBsAb will not increase indicates that the liver injury; and ALT HBcAb, AST had no correlation, suggesting that HBcAb does not indicate increased, was negatively correlated with liver injury.6.HBcAb and HBsAg of the former increased possibility of.7. serological clearance after the age of 50 is the spontaneous clearance of HBsAg patients, which occurred before the age of 50 were negative for the presence of cirrhosis, family history of HCC the probability of a small.8. gender, drinking history, not to promote HBsAg negative factors, and for hepatitis B surface antigen 100IU/ml in patients below, with the increase of age, the possibility of the increase of.9.AFP and liver HBsAg. The LN in the four items of the fiber has a correlation, the AFP increases, and the LN will increase with the correlation.

【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.62

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