乙型肝炎相关性肝衰竭患者HBVDNA低水平复制及特异性抗体表达的临床意义田方圆I,单静I,唐宽银I,曹武奎2(1天津医科大学研究生院，天津300070；2天津市第二人民医院天津市肝病医学研究所，天津300192)摘要：目的探讨乙型肝炎相关性肝衰蝎患者血清HBVDNA低水平复制及HBV特异性抗体表达的相关因索及临床意义。方法收集2008年6月至2013年12月于天漳市第二人民医院住院治疗的391例乙型肝炎相关性肝衰竭患者及394例慢性乙型肝炎患者的病历资料。比较乙型肝炎相关性肝衰竭与慢性乙型肝炎患者HBVDNA農达的不同及影响因素分析。根据HBV血清学标志物(HBVM)待异性表达的不同将肝衰竭患者分为特异性抗体阳性(指抗-HB,、抗-HBe和抗・HBc同时阳性)和特异性抗体阴性(无抗-HBs、抗-HBe和抗・HBc同时阳性)2组，分析2组患者HBVDNA水平的变化和生存悄况。组间比较采用独立样本t检验或Mann-顺切秩和检验，计数资料比较采用H检验。结果乙型肝炎相关性肝衰竭患者HBVDNA水平低于慢性乙型肝炎组，差异有统计学意义(Z=・16.469,P<0.05);HBeAg阳性和阴性的肝衰竭患者HBVDNA水平均低于相应的慢性乙型肝炎患者，差异有统计学意义(Z分别为-11.665和・12.853,P<0.05)。在391肝衰竭病例中，HBV特异性抗体阳性组29例(7.42%),死亡25例(86.21%),HBV特异性抗体阴性组362例(92.58%),死亡157例(43.37%),2组病死率差异有统计学意义(P<0.05)。特异性抗体阳性组患者HBVDNA水平明显低于特异性抗体阴性组，差异有统计学意义(Z二-3.594,P<0.05)o2组HBeAg阴性患者HBVDNA水平均低于HBeAg阳性患者，差异有统计学意义(Z分别为7.427和7.513,P<0.05)。结论HBVM»达形式及机体免疫状态的动态变化在乙型肝炎相关性肝衰竭的发生发展过程中起着一定作用，HBVDNA低水平复制系机体处于免疫清除期所致，而同时伴抗-HBs、抗-HBe、抗-HBc3个抗体同时阳性则提示机体对HBV的超强免疫反应,致使病悄恶化、发展迅速，病死率高。关■词：肝功能衰竭;肝炎，乙型，慢性；乙型肝炎病毒;乙型肝炎抗体中图分类号:R512.62;R575.3文献标志码：A文章编号：1001-5256(2014)06-0527-04Clinicalsignificanceoflow-levelHBVDNAreplicationandspecificantibodyexpressioninpatientswithHBV-relatedliverfailureTIANFangyuan,SHANJing9TANGKuanyin9etal・(GraduateSchoolofTianjinMedicalUniversity,Tianjin300070,China)Toinvestigatetheinfluentialfactorsandclinicalsignificanceoflow一levelhepatitisBvirus(HBV)DNAreplicationandspecificantibodyexpressioninpatientswithHBV-relatedliverFailure.MethodsAretrospectiveanalysiswasperformedonthemedi-calrecordsof391patientswithHBV■relatedliverfailureand394patientswithchronichepatitisB(CHB)hospitalizedintheTianjinSec-ondPeopledHospitalfromJune2008toDecember2013.TheHBVDNAlevelwascomparedbetweenpatientswithHBV-relatedliverfail-ureandthosewithCHBtandtheinfluentialfactorswereanalyzed・AccordingtotheexpressionofHBVserummarkers(HBV-Ms),tientswithliverfailureweredividedintospecificantibody-positivegroup(positiveforanti-HBs,anti-HBeoranti-HBc)andspecificantibody■negativegroup(negativeforanti-HBs,anti-HBeoranti-HBc)."HiechangesinHBVDNAlevelandsurvivalwerecomparedbetweenthetwogroups.Between-groupcomparisonwasmadebyindependent-samplesttestorMann-Whitneyranksumtest,andcomparisonofenumerationdatawasmadebychi-squaretest・ResultsThepatientswithHBV—relatedliverfailurehadasignificantlylowerHBVDNAlevelthantheCHBpatients(Z=-16.469,P<0.05).ThelevelsofHBVDNAinHBeAg一positiveand-negativepatientswithliverfailureweresignificantlylowerthanthoseinpatientswithCHB(Zx=-11.665,P<0.05；Z2=-12.853,P<0.05).Ofthe391patientswithHBV一relatedliverfailure,29(7.42%)werespecificantibody-positivetand25(86.21%)ofthemdied；362(92.58%)werespecificantibody一negativetand157(43.37%)ofthemdied.Therewasasignificantdifferenceinmo...