The Clinical Research Analysis Of HBsAg, HBeAg, HBV-DNA Quantitation, HBV Genotype And Nucleoside Analogueantiviral Effect In HBV Related Liver Disease

Background：Hepatitis B is a contagious disease, which cause serious damage tothe human body health, Each year about1million people were died of liverfailure, liver cirrhosis and primary hepatocellular carcinoma (HCC) caused byHBV infection. The carrying rate of Hepatitis B surface antigen (HBsAg) inChina is as high as8%-10%, which account for third of the World total carryingaccount. The infectiousness of hepatitis B patients and carriers mainlydepends on HBV-DNA levels in the blood, the detective of HBV-DNAquantification existes many disadvantages, such as intricacy ofdetectionequipments, strict inspection conditions, higher expense. As the mature andwidely use of detecting techniques of HBsAg, HBeAg quantification, Analyzethe correlation of HBsAg, HBeAg,HBV-DNA quantification, use HBsAg,HBeAg,HBV-DNA quantification to reflect the duplication ofHBV-DNA hasbecome a great mass fervour. As HBV infectious with different HBV geneticbackground and immune state there are different Genetic characteristics whichlead to different Clinical disease, virology, serology and clinical prognosis,there exits discrepancy among HBsAg, HBeAg,HBV-DNA quantification indifferent HBV genetype.Continuous HBV replication and liver inflammatoryreaction necrosis are major determinantion of liver disease progression. Thelatest international guidelines Recommend liver cirrhosis no matterIncompensation period and decompensation period if only positive ofHBV-DNA should start antiviral treatment as early as possible. Due to the lowefficiency of INF treatment for hepatitis B liver cirrhosis, The immuneregulation mechanismof INF Can increase the degree of liver damage in cirrhosis patients, now always use nucleoside analogues to treat hepatitis Bcirrhosis patients. five-year survival rate of compensatory period hepatitisBassociated liver cirrhosis is55%,turn to decompensatory period is only14%.So in clinical always choose strong antiviral effect, quick effect and little sideeffects nucleoside analogues.Objective：1.Analysis and discussion the correlation and variation trend of HBsAg,HBeAg and HBV-DNA quantification in different stages of chronic HBVinfection.2. Detect genotype, analysis the character between differentgenotype.3.Analysis clinical treatment curative effect of hepatitis B associatecirrhosis patients which use nucleoside analogues.Methods：1.choose264cases of chronic HBV infectors,According to the degree ofliver disease divide into chronic hepatitis group,compensatory cirrhosis group,decompensated cirrhosis and primary liver cancer group, Respectivelydetective the quantitation of HBsAg HBeAg and HBV-DNA.2. DetectiveHepatitis B genotypes of104chronic HBV infectors,compare HBsAg, HBeAg,HBV-DNA quantitation and Biochemical indicators in different genotypes.3.Respectively a-ccording to the clinical medicine, baseline serum HBV DNAlevel and Child-Pugh grade to analysis48weeks clinical curative effect ofNucleoside analogues in70patients of hepatitis B associated liver cirrhosis.Results：1.264cases of chronic HBV infectors who has detected the quantitationof HBsAg HBeAg and HBV-DNA show that:(1) In HBeAg (-) chronic hepatitis Bstage HBsAg and HBV-DNA quantitation were positively correlated, in HBeAg(+) chronic hepatitis B, hepatitis B associated liver cirrhosis and primary livercancer stage there no correlation.(2)In HBeAg (+) hepatitis and hepatitis Bassociated liver cirrhosis stage,HBeAg with HBV-DNA quantitative arepositively correlated,but in HBeAg (-) chronic hepatitis B and primary liver cancer stage there no correlation.(3)The HBsAg, HBeAg and HBV-DNAquantitation along with the progress in liver disease is on the decline.2、104cases of hepatitis B genotypes testresults shows that:(1) Chronic HBVinfectors give priority to with C genotype,the proportion respectively is76.92%,Genotype C is more likely develop to the stage of cirrhosis, Genetype B ismore likely develop to the stage of chronic hepatitis B.(2)There no differencein HBsAg,HBeAg,HBV-DNA quantitation, ALT,ALB,CHE,AFP betweenGenotype B and C.(3) Genotype C chronic HBV infection patients, Asthe liverdisease degree aggravate gradually, HBsAg, HBeAg and HBV-DNAquantitation is on the decline.3、Retrospective analysis48weeks clinicalcurative effect of Nucleoside analogues in70patients of hepatitis B associatedliver cirrhosis.(1) According to the drug divide into ENT and LAM treatmentgroup, in4、12、24and48weeks there are no differernce in VirologicalResponse, negative conversion rates of HBV-DNA, Serological responserates, Biochemical indicators;24weeks’ Biochemical response rates ENT isbetter then LAM; in Virological breakthrough rate LAM is higher than ENT.According to the base line serum HBV-DNA level divide to low viralreplication(＜5log10IU/mL) and high viral replication(≥5log10IU/mL), low viralreplication(＜5log10IU/mL) Virological Response,negative conversion rates ofHBV-DNA, Serological response rates,48weeks’ Biochemical response ratesis better than high viral replication(≥5log10IU/mL). Virological breakthroughrate in low viralreplication(＜5log10IU/mL) is always high,48weeks’Virological breakthrough rate is10.52%、6.25%successively. According toGrading and classification standard of Child-Pugh,24weeks’ Serologicalresponse rates in Child-Pugh A is better than Child-Pugh C,48weeks’Serological response rates in Child-Pugh A and B are better than Child-Pugh C,patients with cirrhosis associate Hepatitis B is better to implement antiviraltreatment as soon as possible. Conclusion：1.Chronic HBV infectors in the stage of CHE、 LC HBeAg andHBV–DNA quantitative has positive correlation,along with the progress in liverdisease, HBeAg and HBV–DNA quantitative is on the decline.2. Differentgenotypes has different type of clinical disease.3.To hepatitis B associatedliver cirrhosis ENT is better than LAM in48weeks’ Biochemical response ratesand Virological breakthrough rate.4.Hepatitis B associated liver cirrhosispatients serum HBV-DNA base line <5log10iu/mL is better than≥5log10iu/mL in48weeks’ clinical curative effect.5.The lower the level ofChild-Pugh, the higher the serological response rates.