Nabuco Leticia Cancella, Villela-Nogueira Cristiane Alves, Perez Renata Mello, Ceci Loredana, Pannain Vera Lucia, Nogueira Carmem Martins, Segadas-Soares Jorge André, Coelho Henrique Sergio Moraes
Division of Hepatology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Brazil.
J Clin Gastroenterol. 2007 Feb;41(2):194-8. doi: 10.1097/01.mcg.0000225575.73385.2b.
The clinical meaning of viremia, especially at low levels, in chronic hepatitis B virus (HBV)-infected patients remains unknown. The objective of the present study was to determine serum HBV-DNA levels and its relationship with liver histology in HBsAg-positive blood donors.
A cross-sectional study was conducted on 78 blood donors, with alanine aminotransferase (ALT) and HBeAg evaluation and quantitative determination of HBV-DNA by polymerase chain reaction (Amplicor, HBV Monitor, Roche; lower limit of sensitivity 1,000 copies/mL). Liver biopsy was obtained from all patients with detectable viremia irrespective of ALT and HBV-DNA levels.
Among 78 blood donors, serum HBV-DNA was detected in 47 (60%) patients; 39 (83%) were males; mean age 37.6+/-10.4 years; 31 (66%) were HBeAg-negative, and ALT was elevated in 26 (55%). The median of HBV-DNA levels was 24,000 copies/mL and 31 (40%) subjects had no detectable serum HBV-DNA. Although the histologic lesions were mild in the majority of patients, HBV-DNA levels were significantly higher in patients with chronic hepatitis or cirrhosis when compared with patients without histologic liver disease (25,260,000 vs. 9480 copies/mL; P<0.001). There was a significant correlation between HBV-DNA levels and necroinflammatory score (r=0.59) and fibrosis (r=0.50); however, in the subset of HBeAg-negative patients with HBV-DNA levels below 30,000 copies/mL, 25% presented histologic disease related to HBV.
Most HBsAg-positive blood donors show low viral load. There is a significant association between viral replication and liver damage; however, low HBV-DNA levels do not exclude the presence of histologic disease.
慢性乙型肝炎病毒（HBV）感染患者病毒血症的临床意义，尤其是低水平病毒血症的意义尚不清楚。本研究的目的是确定HBsAg阳性献血者的血清HBV - DNA水平及其与肝脏组织学的关系。
对78名献血者进行了一项横断面研究，评估丙氨酸氨基转移酶（ALT）和HBeAg，并通过聚合酶链反应（Amplicor，HBV Monitor，罗氏公司；灵敏度下限为1000拷贝/毫升）对HBV - DNA进行定量测定。所有病毒血症可检测到的患者均进行了肝活检，无论其ALT和HBV - DNA水平如何。
78名献血者中，47名（60%）患者检测到血清HBV - DNA；39名（83%）为男性；平均年龄37.6±10.4岁；31名（66%）HBeAg阴性，26名（55%）ALT升高。HBV - DNA水平的中位数为24,000拷贝/毫升，31名（40%）受试者血清HBV - DNA检测不到。虽然大多数患者的组织学病变较轻，但与无肝脏组织学疾病的患者相比，慢性肝炎或肝硬化患者的HBV - DNA水平显著更高（25,260,000对9480拷贝/毫升；P<0.001）。HBV - DNA水平与坏死性炎症评分（r = 0.59）和纤维化（r = 0.50）之间存在显著相关性；然而，在HBV - DNA水平低于30,000拷贝/毫升的HBeAg阴性患者亚组中，25%存在与HBV相关的组织学疾病。
大多数HBsAg阳性献血者病毒载量较低。病毒复制与肝损伤之间存在显著关联；然而，低HBV - DNA水平并不排除组织学疾病的存在。
