A Clinical Study On Lower-lever HBV-DNA Replication And Specific Antibody Expression In Patients With HBV-related Liver Failure

Object:To investigate the influential factors and clinical significance of low-level hepatitis B virus DNA (HBV-DNA) replication and expression of specific antibody in patients with hepatitis B-related liver failure, and provide evidence for evaluating the prognosis of them.Methods:391patients with hepatitis B virus-related liver failure and394patients with chronic hepatitis B (CHB) treated in Tianjin Second People’s Hospital from June2008to December2013were analyzed retrospectively.1. Compare the differences of HBV-DNA level between patients with CHB and those with HBV-related liver failure, and analysis the infuential factors.2. According to the different expression of HBV serum markers (HBV-Ms), patients with liver failure was divided into two groups, specific antibody-positive group (positive for anti-HBs, and positive for both anti-HBe and anti-HBc) and specific antibody negative group (not positive for anti-HBs, anti-HBe and anti-HBc simultaneously). The changes of the HBV-DNA level and the survival situations were compared between the two groups.3. The immune function was compared between patients with HBV-related liver failure and those with CHB, and between the two groups of liver failure. The between-group comparison was analyzed by independent-samples t test or Mann-Whitney rank sum test, and the comparison of enumeration data was analyzed by chi-square test.Results:1.There was26cases of acute liver failure,14cases of sub-acute liver failure,285cases of acute on chronic (sub-acute) liver failure and66cases of chronic liver failure. Among them, patients with acute on chonic (sub-acute) liver failure were the most (72.89%). And there was no significant difference in consititues distribution between specific antibody-positive group and-negative group.2.The HBV-DNA level in liver failure patients was significantly lower than that in CHB patients(Z=-16.469, P<0.05). The levels of HBV-DNA in HBeAg-positive and HBeAg-negative patients with liver failure were significantly lower than those in patients with CHB(Z/=-11.665, Z2=-12.853, P<0.05). Of the391patients with HBV-related liver failure,29(7.42%) were specific antibody positive and25(86.21%) of them died,362(92.58%) were specific antibody-negative and157(43.37%) of them died, there was a significant difference in mortality between the specific antibody-positive and specific antibody-negative groups (P<0.05). The level of HBV-DNA in specific antibody-positive group was significant lower than that of specific antibody-negative group (Z=-3.594, P<0.05). For either group, the HBV-DNA level was significant lower in HBeAg-negative patients with liver failure and CHB than those in HBeAg-positive patients (Z;=7.427, Z2=7.513, P<0.05).3.Compared with chronic hepatitis B patients, patients with liver failure had a significant difference in the test results of IgG、IgA、IgM and C3(P<0.05). IgG、IgA and IgM in the liver failure group were significantly higher than those in chronic hepatitis B and the normal reference range, while C3was significantly lower than that in chronic hepatitis B group. There was no significant difference in IgG、IgA and IgM between specific antibody-positive group and specific antibody-negative group(P>0.05), and C3in specific antibody-positive group was significantly lower than that in specific antibody-negative group(P<0.05).Conclusion:The expression of HBV-Ms and the body’s immune status play a role in the progression of hepatitis B virus-related liver failure. The low replication of HBV-DNA is caused by immune clearance phase. Hepatic failure with anti-HBs, anti-HBe, anti-HBc positive simultaneously will have rapid progression and high mortality for the super immune response to HBV. Therefore, enhancing health education and urging patients to re-examination regularly are very important for prevention and treatment of liver failure patients.