Detection Of HBV DNA In The Liver Tissues Guiding For Antiviral Therapy In Patients With Hepatitis B Virus-related Cirrhosis And Negative Serum HBV DNA

Background：The rate of disease progression of chronic hepatitis B is high, andthe progress rate of liver cirrhosis is2.1%~6.0%. And once become liver cirrhosis,therisk of decompensation cirrhosis and liver cancer can be as high as4.4%and3%respectively. In recent years, people have realized that suppressing the replication ofhepatitis B virus can not only significantly slow the progress of the disease, but alsocan make reverse cirrhosis of the liver’s pathological damage that has alreadyoccurred. But in clinical practice, There is still a part of patients with positiveserological HBsAg, liver cirrhosis clinical symptoms and imaging findings,but theirserum HBV DNA is negative. Because such patients do not have antiviral treatmentindications, can not give antiviral treatment. Although this part of patients havenegative serum HBV DNA, still progress to liver cirrhosis. So in this part of patientshow to delay the progress of disease, even make the reversal of fibrosis occurred, isthe problem facing to be solved. Some experts think this part of patients shoud haveantiviral treatment, but at home and abroad guidelines both lack of conclusiveantiviral treatment, And during antiviral therapy, there is no clear indicator evaluatingthe effect of antiviral therapy. Therefore, this research in view of this part of patientswho suffer liver biopsy, detecting HBV DNA levels of liver tissue, and giving theliver tissue inflammatory necrosis Knodell score and Ishak fibrosis score, afterantiviral treatment to patients with positive liver tissue HBV DNA, these patients haveliver biopsy again, evaluating negative rate of liver tissue HBV DNA andimprovement of the liver tissue.Objects: Discussing detection of HBV DNA in liver tissues guiding for antiviraltreatment in patients with hepatitis B virus-related cirrhosis and negative serum HBVDNA. After antiviral treatment to patients with positive liver tissue HBV DNA, and analysis curative effect of patients with long-term antiviral therapy.Methods: Collecting57cases of patients with HBsAg positive, serum HBVDNA negative, abnormal liver image.All patients included in this study have liverbiopsy. According to the Child-Pugh classification standard to assess its liver reservefunction. Detecting HBV DNA in the liver tissue,evaluate inflammatory necrosisscore and fibrosis score. Antiviral treatment is given to patients with positive HBVDNA in the liver tissue. Patients in Child-Pugh grade A use PEG-IFNα-2a antiviraltreatment48weeks and96weeks of follow-up. Patients in Child-Pugh grade B and Cuse nucleoside analogues antiviral treatment for144weeks. After antiviral treatment for, thesepatients have liver biopsy again,comparing the changes of HBV DNA, inflammatorynecrosis score and fibrosis score in the liver tissue.Result：①In the hepatitis B virus-related cirrhosis patients with HBsAgpositive, serum HBV DNA negative, liver tissue HBV DNA positive rate is59.6%（n=34）.②In the34patients with positive liver tissue HBV DNA, most patients areC genotype,52.9%(n=18), followed by genotype B (35.3%, n=12), other genotypeswere11.8%(n=4).③In the34patients with positive liver tissue HBV DNA,afterantiviral therapy, the rate of patients with negative HBV DNA in the liver tissue inentecavir group is as high as83.3%(n=10), followed by telbivudine group (81.8%, n=9), PEG-IFNα-2a group is the minimum72.7%(n=8).④11Patients in Child-Pughgrade A use PEG-IFNα-2a antiviral treatment48weeks and96weeks of follow-up,average serum HBsAg level is2.2±0.5log10IU/ml，fall0.6log10IU/ml in the pastantiviral treatment.⑤11Patients in Child-Pugh grade A use PEG-IFNα-2a antiviraltreatment, the improve of liver histology is45.5%,23Patients in Child-Pugh grade Band C use nucleoside analogues antiviral treatment, the improve of liver histology is73.9%.⑥One Child-Pugh grade C patient in telbivudine group have liver cancer inantiretroviral treatment to126weeks,none in PEG-IFNα-2a group or entecavir group.⑦23patients in Child-Pugh grade B and C use nucleoside analogues antiviral treatmentfor144weeks,3patients still have positive liver tissue HBV DNA, having resistantmutation detection, no drug resistance mutation is found.⑧During antiviral therapy in some patients appeared different reactions, but no patients discontinue treatmentdue to severe adverse reactions.Conclusion: In the hepatitis B virus-related cirrhosis patients with HBsAgpositive, serum HBV DNA negative, liver biopsy has great instruction significance forantiviral treatment. Liver biopsy before and after antiviral treatment can help toanalysis curative effect of long-term antiviral therapy.All these patients can get highrate of negative HBV DNA in the liver tissue.After antiviral treatment, the improve ofliver histology is high,and it can significantly slow disease progression in patientswith cirrhosis.