Study Of Clinical Significance Of HBeAg-negative CHB. And Study Of Clinical Significance Of HBsAg Quantitation

Definition of the HBeAg-negative hepatitis B: ①HBsAg-positive 6 month upper, HBeAg-negative; ②The HBVDNA positive.③ has the proof of the liver harm, the ALT >1.5×ULN.④ liver histology check has CHB infection.⑤ expels to merge other the virus infection and expels to merge alcohol hepatitis and use the liver toxicity medicine, autoimmune disease.The HBeAg-negative hepatitis B is 7-30%,in the scope of world .chronic hepatitis B in Asia, the HBeAg-negative hepatitis B in Japan is 19%;China is 21%, Taiwan is 20%, Hong Kong is 11%;India is 16%.Chronic HBeAg-negative hepatitis B patiant in Asia about upper 50% to have pre-c mutant of HBV.In recent years the trend that the chronic HBeAg-negative hepatitis B also has to increase gradually in china, have already caused the attention of a lot of scholars, as to it's be taken bad the mechanism and clinical characteristics to study extensively, widespread think, an one of the definitely reason that ( A83)mutant to cause the chronic HBeAg-negative hepatitis B. But have an different opinion that the clinical characteristics and aftereffect of the chronic HBeAg-negative hepatitis that ( A83)mutant cause. Parts of scholars think that the hepatitis condition of the pre-C( A83) variation is to aggravate of the disease activity is very difficult by oneself static, parts of scholars think that it does not cause the condition to aggravate.In order to further study the clinical characteristics of this kind of hepatitis and the clinical meaning of the pre- C code G1896A variations, This text will further study the clinical characteristics of this kind of hepatitis and clinical meaning of the pre-C code G1896A mutant.The HBeAg -negative because of this type of patient, the clinic can't turn the negative conduct and actions observation therapied effect and stop the medicine opportune moment.Give clinic treatment bring certain influence. the HBsAg is the structure proteid of the virus, few the occurrence serum conversion ,its serum conversion is one of the important index signs that the virus clearance.This text research to the HBsAg related clinical observation index sign, being the meaning ofthe condition evaluation HBsAgin the hepatitis B.First: review analysis of clinical correlation factor of CHB in 1686 patientsA total of 1686 in-patients with chronic hepatitis B and divided into two groups according to the HBeAg status., The correlation among alanine transaminase (ALT) levels, hepatitis B virus (HBV) DNA and the liver histopathological data were detected.,and compared the difference of these values in patients with HBeAg-negative CHB.and HBeAg-positive CHB. RESULTS: Chronic hepatitis B patient, male quantity more than the female, the male and female 's a condition of serologic HBV DNA levels and ALT levels and inflammatory scores and fibrosis scores has no obvious difference.The age of the HBeAg -negative hepatitis group is more old 8 years old than HbeAg-positive hepatitis group.HBeAg-negative group had significantly lower serologic HBV DNA levels and ALT levels than HBeAg-positive group.HBeAg- positive group had significantly lower inflammatory scores and fibrosis scores than HBeAg- negative..AST levels had no obvious difference.when HBVDNA=105copies/ml, HBeAg- positive group had significantly lower histological staging and grading than HBeAg- negative, P=0.017/0.008, ALT and AST levels had no obvious difference, P=0.278/0.841. when HBVDNA=104copies/ml, histological grading had no obvious difference, P=0.053.but HBeAg- positive group had significantly lower histological staging than HBeAg- negative, P=0.018. ALT and AST levels had no obvious difference,Second, Pre- C area( variation of A83) mutant study of the clinical meaning in HBeAg-negative chronic hepatitis BA83 mutant of the HBeAg -negative hepatitis B is more than other pre-c/c area mutant, the HBV mutation of the pre-C area 1896 code for the very first time was reported by British scholar Carman etc in 1989..Wild virus 1896 code is G, the variation is A, as TGG to TAG, thus can't make HBeAg, but it does not affect the virus replication, so clinic last the performance is a HBeAg(-), HBVDNA(+),There is 60% in the patient of the whole world HBeAg-negative hepatitis B was examine the pre-C A83 mutantthe , is 92% in Mediterranean, the Pacific Asia region is 50%, the United States and North Europe is 24%.It choose to have the patient's total 175 people of chronic HBeAg-negative hepatitis B that the liver function checks the result in the outpatient, choose chronic HBeAg-negative hepatitis B patient from the continuous inpatient,but the anti— HCV, anti— HDV, anti— HIV was negatived, did not accept the antivirus treatment, have the liver function assay result, having the liver pathology result in half a year.Examine the pre-C with PCR- RFLP method and the fluorescence PCR method measurement HBV DNA .The result positive are 132 of specimen, have the HBVDNA quantified result amount 79.33 of the pre- C variation positive, about have 25%.The admixture infects with 13, about having 9.85%.lower the ALT level 1.5 ULN group and above the ALT level 1.5 ULN group compare, pre- C variation occurrence rate, mix virus infection the occurrence rate, wild virus rate all have no obvious difference.pre-c variation to ALT level without obvious influence.Wild group had significantly lower serologic HBV DNA levels than pre-c mutant group , AST levels had no obvious difference.Conclusion:pre-c mutant to the hepatitis activity have no obvious influence, it is easy happened pre-c mutant when virus replication activeThird HBsAg has positive correlations with serum HBV DNA load and HBeAg in chronic hepatitis B patientsTo observe the difference of HBsAg levels among types of HBV infection and the correlations between HBsAg and other characteristics such as HBV DNA and HBeAg.Materials :The sera were collected from consecutive patients as divided into three groups of HBV infection: eighty-nine consecutive chronic hepatitis B patients with liver histology evaluations and 36 consecutive patients suffered with HBV related decompensated cirrhosis. Patients from both groups were naive to antiviral therapy; twenty-nine HBV carriers with inactive viral replication. All sera were stored at -20sC.Methods:HBsAg level was determined quantitively by Abbott Architect HBsAg assay . Results: HBsAg in more than 50 percents of sera from patients with chronic HBV infection is higher than 250IU/ml. HBsAg level was different among types of HBV infection: HBsAg level was the lowest in carriers with inactive viral replication (range, 0.01-21566.32IU/ml, median, 311.50IU/ml), higher in HBV related decompensated cirrhosis patients (range, 1.00-19243.67IU/ml, median, 942.43IU/ml), the highest in chronic hepatitis B patients (range, 1.00-116433.49IU/ml, median, 3452.48IU/ml). Correlation analysis shows that HBsAg level has positive correlation with serum HBV DNA (Roche Lightcycler, r=0.6000, p=0.000) in log scale and positive correlation with HBeAg (Abbott AxSYM S/N, r=0.418, p=0.000) and ALT (r=0.257, p=0.005), and has negative correlation with age (r=-0.296, p=0.001); no correlation with liver histology scores. No difference of HBsAg level exists between male or female carriers, and no difference between HBV genotype B or C. The sensitivity of HBsAg>2000IU/ml to predict HBV DNA>lxl06copies/ml is 84.5% and the specificity is 68.0%.Conclusions: Serum HBsAg has positive correlation with serum HBV DNA load and with HBeAg and ALT, and has negative correlation with age. HBsAg level is the lowest in HBV carriers with inactive viral replication. AnywayIn fine, The age of the HBeAg -negative hepatitis B group is more old than HbeAg-positive hepatitis group.HBeAg-negative group had significantly lower serologic HBV DNA levels and ALT levels and HBsAg quantitation thanHBeAg-positive group. HBeAg- positive group had significantly lower inflammatory scores and fibrosis scores than HBeAg- negative..AST levels had no obvious difference, serologic HBVDNA lode of pre-c mutant group higher than not happen pre-c mutant group . mainly consider the pre-c mutant is because of a kind of natural variation that the structure blemish of the virus result in, when the virus replication is active to then happened the opportunity of the pre-c variation big, part of explain the high reason of the level of serologic HBVDNA of the pre- C variation set, pre-C mutant of virus to the hepatitis activity without obvious influence, the HBeAg-negative hepatitis B (A83 mutant) is also natural static.The HBeAg-negative chronic hepatitis B at the HBV infects with the natural history in is last the stage ( after HBeAg-positive hepatitis B).But not necessarily is because the hepatitis that variation of HBV result in aggravate.pre-c mutant has no influence to the surface antigen quantitation value. Serum HBsAg has positive correlation with serum HBV DNA load and with HBeAg and ALT, and has negative correlation with histological staging and grading.