慢性HBV感染者免疫逃逸期与免疫控制期的临床特征分析.

Objective To investigate the clinical features of immune control phase and immune escape phase of chronic hepatitis B virus(HBV) infection. Methods A total of 226 patients with chronic HBV infection(with positive HBsAg, anti-HBe, and anti-HBc) who visited or were hospitalized in Yan’an University Affiliated Hospital from January 2016 to February 2018 were enrolled, and all of them underwent liver biopsy. According to the liver pathological results, the patients were divided into immune control group(121 patients with A <2 and F < 2) and immune escape group(105 patients with A≥2 or F≥2). The two groups were compared in terms of general data, virology, liver function, and liver stiffness measurement(LSM). The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results There were no significant differences in sex, age, and family aggregation of hepatitis B between the immune control group and the immune escape group(all P > 0.05). There was a significant difference in HBV DNA level between the two groups [1107.00(369.00-3876.00)IU/ml vs 2171.00(596.00-8887.00) IU/ml, Z =-2.425, P = 0.015], while there were no significant differences in the levels of HBs Ag and anti-HBc(both P > 0.05). Compared with group A, group B had significantly higher levels of alanine aminotransferase(ALT)[46.00(22.00-97.50) U/L vs 30.00(19.00-87.50) U/L, Z =-2.261, P = 0.024], aspartate aminotransferase(AST)(35.50 ±14.74 U/L vs 31.30 ± 12.17 U/L, t =-2.351, P = 0.020), and LSM(7.41 ± 1.51 k Pa vs 4.76 ± 1.23 k Pa, t =-9.021, P <0.001). Conclusion Patients with chronic HBV infection(with positive HBsAg, anti-HBe, and anti-HBc) in the immune escape phase have significantly higher viral load, ALT, AST, and LSM than those in the immune control phase. In future, multicenter studies can be performed to clarify the ranges of the references values of the above parameters, in order to provide accurate diagnosis and treatment for patients with chronic HBV infection. [ABSTRACT FROM AUTHOR]