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目的分析HBV血清学标志和病毒相关特征对慢性乙型肝炎病毒携带孕妇产后自发血清清除或转换的影响。方法选取内蒙古医科大学附属医院在2012年12月-2014年12月收治的符合纳入标准的慢性乙型肝炎病毒携带孕妇500例,所有病例均在2015年1-12月进行随访。根据随访时是否发生HBe Ag转换分为转换组和非转换组,两组分别在组内对比孕期和随访期间的血清HBs Ag、HBV-DNA和G1896A突变率;组间对比血清HBe Ag、HBV-DNA、HBs Ag水平和基因型,并对比两组不同HBs Ag、HBe Ag、HBV-DNA水平之间的HBe Ag转换差异。根据孕期是否发生HBs Ag清除分为清除组和非清除组,对比两组的血清HBs Ag、HBV-DNA水平和基因型。结果 500例慢性乙型肝炎孕妇随访过程中175例失访,325成功完成随访,随访成功率为65.00%。随访325例患者中,94例入组前已确认为HBe Ag阳性,其中HBe Ag转换51例,非转换43例;组内对比,转换组的血清HBs Ag、HBV-DNA和G1896A突变率在孕期和随访期间差异有统计学意义(P<0.01);组间对比,转换组的血清HBe Ag、HBV-DNA、HBs Ag水平均较非转换组的低,差异有统计学意义(P<0.01),但基因型两组差异无统计学意义(P>0.05);HBs Ag、HBe Ag、HBV-DNA水平越低,HBe Ag转换率越高。随访325例患者中,47例血清HBs Ag清除,278例未清除;与非清除组对比,清除组除血清HBV-DNA(P>0.05)外,血清HBs Ag水平和基因型差异均有统计学意义(P<0.01)。结论血清较低水平的HBe Ag和HBs Ag有利于HBe Ag转换和HBs Ag清除。
Objective To analyze the influence of HBV serological markers and virus-related features on spontaneous serum clearance or conversion in pregnant women carrying chronic hepatitis B virus. Methods 500 cases of pregnant women with chronic hepatitis B virus who met the inclusion criteria were enrolled in the Affiliated Hospital of Inner Mongolia Medical University from December 2012 to December 2014. All the cases were followed up from January to December in 2015. According to whether HBe Ag conversion at follow-up was divided into conversion group and non-conversion group, the serum HBsAg, HBV-DNA and G1896A mutation rates during pregnancy and follow-up were compared between the two groups. DNA, HBsAg levels and genotypes, and compared HBe Ag conversion differences between two groups of different HBsAg, HBeAg and HBV-DNA levels. HBsAg clearance was divided into clearance group and non-elimination group according to whether HBsAg was detected during pregnancy. HBsAg, HBV-DNA levels and genotypes were compared between the two groups. Results One hundred and five cases of pregnant women with chronic hepatitis B were followed up, 175 cases were lost and 325 cases were successfully followed up. The success rate was 65.00%. Of the 325 patients who were followed up, 94 patients were confirmed as positive for HBeAg before entering the group, of which 51 cases were HBe Ag conversion and 43 cases were non-conversion. In the control group, the serum HBsAg, HBV-DNA and G1896A mutation rates in the conversion group were significantly higher (P <0.01). The levels of serum HBeAg, HBV-DNA and HBsAg in the conversion group were significantly lower than those in the non-conversion group (P <0.01), and the differences were statistically significant , But there was no significant difference between the two genotypes (P> 0.05). The lower HBsAg, HBe Ag and HBV-DNA levels led to higher HBe Ag conversion rate. Among the 325 patients, 47 cases had serum HBsAg clearance and 278 cases were not cleared. Compared with the non-removal group, serum HBsAg level and genotype differences in the clearance group were statistically significant except for serum HBV-DNA (P> 0.05) Significance (P <0.01). Conclusions Lower levels of serum HBe Ag and HBs Ag favor HBe Ag conversion and HBs Ag clearance.