| Objective: Analyze the clinical indicators of HBsAg-negative chronic HBV infections with different titers of HBsAg and explore their relationship with HBsAg,so as to observe the clinical significance of quantitative HBsAg levels in HBsAg-negative chronic HBV infections.Provide help for further scientific and standardized management of chronic HBV infection.Materials and Methods: A total of 385 patients with HBeAg-negative chronic HBV infection who visited the Infectious Diseases Clinic and / or Inpatient Department of Yan'an University Hospital from December 2013 to January 2020 and received informed consent for liver tissue biopsy.Follow-up observation is carried out every 3-6months.When the occurrence of liver adverse events such as liver cirrhosis and / or liver cancer,or the start of antiviral therapy before the development of end-stage liver disease,follow-up will be stopped.The follow-up content includes general information.(Name,age,gender,height,weight,family history of hepatitis B,initial onset time,contact information,etc.),biochemical indicators(ALT,AST),virological indicators(hsHBVDNA),hepatitis B virus serum markers,hepatitis B virus gene analysis Type,liver non-invasive fibrosis test value(LSM),imaging changes(upper abdomen ultrasound or CT,MRI).SPSS20.0 software was used for statistical analysis of the data received,measurement data,mean ±standard deviation for normal distribution,and the skewed distribution is expressed by the median±quartile spacing.Those who meet the normal distribution and the variances are homogeneous using t test or one-way analysis of variance(F test),and the subsequent pairwise comparisons are performed by LSD-t test.Those with skewed distributions and / or inhomogeneity of variance use Mann-Whitney U test or Kruskal-Wallis H test,bonferroni correction test is used for subsequent pairwise comparisons.Count data is expressed as composition ratio(%),comparison between two groups uses 2 test,comparison between multiple groups uses row list chi-square test,group Chi-square segmentation was used for comparison.The test level is ? = 0.05,P<0.05 is considered statistically significant.Results:1.Among the 385 cases studied,187 were male(48.6%)and 198 were female(51.4%).The mean age ± standard deviation was 40.44 ± 10.38 years,the minimum age was 17.00 years,and the maximum age was 66.00 years,of which 204 cases(53.0%)had a history of chronic hepatitis B family gathering,without chronic hepatitis B family gathering history of 181 cases(47.0%).2.Of the 385 patients,230 were tested for hepatitis B virus genotyping,of which B genotype was 7(3%),D genotype was 9(4%),and the remaining 214 patients were C genotype(93%).3.385 patients were followed up for 1 to 20 years,with a median follow-up period of9 years.At the end of follow-up,27 patients(7.0%)had disease progression to LC,of which 20 patients(5.2%)in the HBsAg group ?1500IU / ml,There were 6(1.6%)patients in the 200 <HBsAg <1500IU / ml group and 1(0.3%)patients in the HBsAg?200IU / ml group.4.According to the results of liver pathological biopsy,significant inflammation and/ or significant fibrosis of the liver tissue were significantly different among the HBsAg?1500IU / ml group,200 <HBsAg <1500IU / ml group,and HBsAg?200IU / ml group(P <0.05).And the comparison between the two groups showed that there were significant differences between the HBsAg?200IU / ml group and the 200 <HBsAg<1500IU / ml group and the HBsAg?1500IU / ml group(adjusted significance P <0.05).There was a significant difference between the group of 200 <HBsAg <1500IU / ml and the group of HBsAg?1500IU / ml(adjusted significance P <0.05).5.According to the HBsAg grouping of patients undergoing liver biopsy after informed consent,there were significant differences in age and HBsAb among the three groups(P <0.05).Further comparison between groups revealed that there was a significant difference between the HBsAg?200IU / ml group and the HBsAg?1500IU /ml group(adjusted significance P value <0.05).HBV DNA and AST were significantly different among the three groups.When comparing the two groups,it was found that the HBsAg?200IU / ml group was significantly different from the 200 <HBsAg <1500IU /ml group,HBsAg?1500IU / ml group(adjusted significance)P <0.05).There were significant differences in HBsAg / HBV DNA among the three groups(P <0.05).When comparing the two groups,it was found that the HBsAg?200IU / ml group was significantly different from the 200 <HBsAg <1500IU / ml group,HBsAg?1500IU / ml group(Adjusted significance P <0.05),there were significant differences between the group of 200 <HBsAg <1500IU / ml and the group of HBsAg?1500IU / ml(adjusted significance P <0.05).There was no significant difference in family aggregation history of hepatitis B,gender,HBeAg,HBeAb,HBcAb,ALT,LSM,liver tissue inflammation and liver tissue fibrosis(P> 0.05).6.Grouped and compared patients with HBsAg ?1500IU / ml who underwent liver biopsy after informed consent by age,sex,HBV DNA,significant inflammation of liver tissue,significant fibrosis of liver tissue,significant inflammation of liver tissue and / or significant fibrosis.6.1 Patients with HBsAg ?1500IU / ml who underwent liver biopsy after informed consent were compared by age group.The liver tissue obvious inflammation,liver tissue obvious inflammation and / or significant fibrosis ratio in the age ?45 years old group were higher than those in the age <45 years old group,and there were significant differences(P <0.05).There were no significant differences in family history of hepatitis B,gender,HBsAg,HBsAb,HBeAg,HBeAb,HBcAb,ALT,AST,LSM,HBsAg / HBV DNA,liver tissue inflammation,and liver tissue fibrosis(P> 0.05).6.2 Patients with HBsAg ?1500IU / ml who underwent liver biopsy after informed consent were found to have a higher ALT level in the male group than in the female group,and there was significant difference in ALT between the two groups(P <0.05).There were no significant differences in family history of hepatitis B,HBsAg,HBsAb,HBeAg,HBeAb,HBcAb,HBV DNA,AST,LSM,HBsAg / HBV DNA,significant inflammation of liver tissue,significant fibrosis of liver tissue,significant inflammation of liver tissue and / or significant fibrosis(P> 0.05).6.3 Patients with HBsAg ?1500IU / ml who underwent liver biopsy after informed consent were grouped and compared by HBV DNA.The HBV DNA <2000IU / ml group and the HBV DNA?2000IU / ml group have significant differences in age,HBeAg,HBcAb,ALT,AST,LSM,HBsAg / HBV DNA,liver tissue inflammation,liver tissueinflammation and / or significant fibrosis(P <0.05).However,there were no significant differences between the two groups in family history of hepatitis B,gender,HBsAg,HBsAb,HBeAb,and significant fibrosis in liver tissue(P> 0.05).6.4 The HBsAg ?1500IU / ml patients who underwent liver biopsy after informed consent were compared according to the liver tissue obvious inflammation and / or significant fibrosis.There were significant differences in liver tissue without obvious inflammation and / or significant fibrosis group,liver tissue obvious inflammation and /or significant fibrosis group in terms of age,HBeAb,HBV DNA,ALT,AST,LSM,HBsAg / HBV DNA(P <0.05).There was no significant difference in family history of hepatitis B,gender,HBsAg,HBsAb,HBeAg,HBcAb between the two groups(P> 0.05).6.5 The HBsAg ?1500IU / ml patients who underwent liver biopsy after informed consent were grouped according to the obvious inflammation of liver tissue.There were significant differences in HBV DNA,ALT,LSM,HBsAg / HBV DNA between the group with no obvious inflammation in liver tissue and the group with obvious inflammation in liver tissue(P <0.05).However,there were no significant differences between the two groups in age,family history of hepatitis B,gender,HBsAg,HBsAb,HBeAg,HBeAb,HBcAb,AST,and significant liver tissue fibrosis(P> 0.05).6.6 Patients with HBsAg ?1500IU / ml who underwent liver biopsy after informed consent were grouped and compared according to significant liver fibrosis.There were significant differences in HBsAg,HBeAg,HBeAb and LSM between the group with no significant fibrosis and the group with significant fibrosis(P <0.05).Age,family history of hepatitis B,gender,HBV DNA,HBsAg / HBV DNA,HBsAb,HBcAb,ALT,AST,and liver inflammation were not significantly different between the two groups(P> 0.05).7.Patients with informed consent for liver tissue biopsy of 200 <HBsAg <1500IU /ml were grouped by age,sex,HBV DNA,significant inflammation of liver tissue,significant fibrosis of liver tissue,significant inflammation of liver tissue and / or significant fibrosis Compare.7.1 For patients with liver biopsy after informed consent of 200 <HBsAg <1500IU /ml,they were grouped by age and found that HBsAb and HBcAb in the ?45 years old group were higher than those in the <45 year old group,with significant differences(P<0.05).There were no differences in age,gender,family history of hepatitis B,HBsAg,HBeAg,HBeAb,HBV DNA,HBsAg / HBV DNA,ALT,AST,LSM,marked inflammation of liver tissue,marked fibrosis of liver tissue,marked inflammation of liver tissue and / or significant fibrosis(P> 0.05).7.2 According to gender grouping of 200 <HBsAg <1500IU / ml patients who underwent liver biopsy after informed consent,the male group had higher ALT levels than the female group,and there was a significant difference between the two groups(P<0.05).There were no differences in family history of hepatitis B,age,HBsAg,HBsAb,HBeAg,HBeAb,HBcAb,HBsAg / HBV DNA,ALT,AST,LSM,significant inflammation of liver tissue,significant fibrosis of liver tissue,significant inflammation of liver tissue and / or significant fibrosis(P> 0.05).7.3 Comparison of HBV DNA grouping of 200 <HBsAg <1500IU / ml patients who underwent liver biopsy after informed consent showed that HBsAb,HBcAb,ALT,AST,LSM,HBsAg / HBV DNA,and liver tissues in the HBV DNA group were less than2000 IU / ml Inflammation and / or significant fibrosis were significantly different from HBV DNA ?2000IU / ml group(P <0.05),while HBV DNA <2000IU / ml group was gender,age,family history of hepatitis B,HBsAg,HBeAg,HBeAb,liver Tissue inflammation and liver fibrosis were not significantly different from HBV DNA ?2000IU/ ml group(P> 0.05).7.4 According to liver inflammation tissue and / or significant fibrosis of 200<HBsAg <1500IU / ml patients who underwent liver biopsy after informed consent,there were significant differences in HBV DNA and LSM between the two groups(P <0.05).There were no differences in age,family history of hepatitis B,gender,HBsAg,HBsAb,HBeAg,HBeAb,HBcAb,HBsAg / HBV DNA,ALT,AST between the two groups(P>0.05).7.5 A comparison of 200 <HBsAg <1500IU / ml patients who underwent liver biopsy after informed consent was based on significant inflammation of the liver tissue.It was found that there was no significant inflammation in the liver tissue and significant inflammation in the liver tissue in the HBsAg,HBV DNA,and significant fibers There were significant differences in chemical aspects(P <0.05).There were no differences in age,family history of hepatitis B,gender,HBsAb,HBeAg,HBeAb,HBcAb,ALT,AST,LSM,HBsAg / HBV DNA(P> 0.05).7.6 Patients with 200 <HBsAg <1500IU / ml who underwent liver biopsy after informed consent were grouped according to significant fibrosis of the liver tissue.It was found that HBV DNA,LSM,and significant inflammation of the liver tissue had no significant fibrosis in the liver tissue and significant fiber in the liver tissue.There were significant differences between the two groups(P <0.05).There were no differences in gender,age,family history of hepatitis B,HBsAg,HBsAb,HBeAg,HBeAb,HBcAb,HBsAg / HBV DNA,ALT,and AST between the two groups(P> 0.05).Conclusion:1.The genotype of hepatitis B virus in this area is mostly C type,which can account for 93%.2.When the quantitative level of HBsAg is high(?1500IU/ml),liver tissue is still prone to obvious inflammation and/or significant fibrosis,despite negative HBeAg and no obvious abnormalities in liver function.3.Males in HBsAg?1500IU / ml group,patients over 45 years old and HBV DNA?2000IU / ml are more prone to liver dysfunction,obvious inflammation of liver tissue and / or significant fibrosis.4.Males in the 200 <HBsAg <1500IU / ml group and patients with HBV DNA?2000IU / ml are more likely to have abnormal liver function,obvious inflammation of liver tissue and / or significant fibrosis.5.The quantitative level of HBsAg reflects the progress of the disease to a certain extent.Combined application with HBV DNA load can better manage the disease throughout the process. |
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