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目的探讨口服恩替卡韦治疗HBe Ag阳性乙肝患者1年对血清和肝组织中HBV cccDNA含量的影响。方法选取90例HBe Ag阳性乙肝患者,所有患者连续48周口服恩替卡韦0.5 mg/d,治疗前后分别静脉取血分离血清。采用化学发光法检测HBV血清标志物、采用荧光实时定量PCR法检测HBV-DNA及HBV cccDNA含量,并对各指标进行统计学分析。选取治疗48周后血清HBV cccDNA阴性且符合肝穿的患者进行肝穿检查,检测肝组织中HBV cccDNA含量。结果 (1)治疗后,血清HBV-DNA、HBV cccDNA及谷丙转氨酶(ALT)水平均显著下降(P<0.01)。(2)发生e抗原转换组的HBV DNA和HBV cccDNA水平下降均比未发生转换组更显著(P<0.01)。(3)90例患者在治疗1年后有68例患者血清中HBV cccDNA转阴,而在这其中选取8例患者进行肝穿,只有1例患者的肝组织中HBV cccDNA转阴。结论尽管恩替卡韦可明显降低乙肝患者血清和肝组织的HBV cccDNA水平,然而恩替卡韦治疗1年尚不能彻底清除肝细胞中的HBV。
Objective To investigate the effect of oral administration of entecavir on HBV cccDNA in serum and liver tissue of HBeAg-positive hepatitis B patients for one year. Methods Ninety HBe Ag positive hepatitis B patients were selected. All patients were given entecavir 0.5 mg / d for 48 weeks continuously. Serum was collected from venous blood before and after treatment. The chemiluminescence method was used to detect the serum HBV markers, and the contents of HBV-DNA and HBV cccDNA were detected by real-time fluorescence quantitative PCR. Statistical analysis was made on each index. After 48 weeks of treatment, patients with negative serum HBV cccDNA and liver puncture were selected for liver biopsy to detect the content of HBV cccDNA in liver tissue. Results (1) After treatment, serum HBV-DNA, HBV cccDNA and ALT levels were significantly decreased (P <0.01). (2) The levels of HBV DNA and HBV cccDNA in e antigen transduction group were significantly lower than those in the non-transconversion group (P <0.01). (3) In the 90 patients one year after the treatment, 68 patients had serum cccDNA negative in the serum of 8 patients, and in this group, 8 patients were selected for hepatic perfusion. Only 1 patient had negative HBV cccDNA in the liver tissue. Conclusion Although entecavir can significantly reduce the level of HBV cccDNA in serum and liver of patients with hepatitis B, one year of entecavir treatment can not completely eliminate HBV in liver cells.