Mahtab Mamun-Al, Rahman Salimur, Khan Mobin, Kamal Md, Mamun Ayub Al, Karim Md Fazal
Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Hepatobiliary Pancreat Dis Int. 2007 Oct;6(5):483-6.
Bangladesh is situated in the intermediate prevalence region of hepatitis B virus (HBV). The lifetime risk of acquiring HBV infection in Bangladesh is greater than 40%. It has been estimated that this virus is responsible for 10%-35% cases of acute viral hepatitis, 35.7% cases of fulminant hepatic failure, 33.3%-40.5% cases of chronic hepatitis and 46.8% cases of hepatocellular carcinoma in Bangladesh. The aim of this study is to compare the correlation between HBV DNA load and grade and stage of liver disease in patients with chronic hepatitis B (CHB).
Percutaneous liver biopsies done in 159 CHB patients revealed 62.9% (100 patients) had wild type HBV infection and the rest 37.1% (59) had pre-core/core promoter mutant HBV infection. HBV DNA load was measured using PCR in all patients.
In the wild type CHB group, 97% (97 patients) had moderate to high HBV DNA load and 3% (3) had low to moderate HBV DNA. In the pre-core/core promoter mutant group, 74.6% (44 patients) had moderate to high HBV DNA and the rest 25.4% (15) had low to moderate HBV DNA. The patients with moderate to high HBV DNA of the patients with wild type CHB, 78.4% (76 patients) had minimal to mild chronic hepatitis (HAI-NI 0-8) and 21.6% (21) had moderate to severe chronic hepatitis (HAI-NI 9-18). 66.6% (2 patients) and 33.3% (1) patients with low to moderate HBV DNA load had minimal to mild and moderate to severe chronic hepatitis respectively. In the moderate to high HBV DNA group, 77.3% (75 patients) patients had minimal to moderate fibrosis (HAI-F 0-2) and 22.7% (22) (HAI-F 3-4) had severe fibrosis to cirrhosis. These figures were 33.3% (1 patient) and 66.6% (2) respectively in the patients with low to moderate HBV DNA load. On the other hand in case of patients with pre-core/core promoter mutant type CHB, in the moderate to high HBV DNA group, 79.5% (35 patients) had minimal to mild chronic hepatitis (HAI-NI 0-8) and 20.5% (9) had moderate to severe chronic hepatitis (HAI-NI 9-18). 93.3% (14) and 6.7% (1) patients with low to moderate HBV DNA load had minimal to mild and moderate to severe chronic hepatitis respectively. In the moderate to high HBV DNA group, 68.2% (30 patients) had minimal to moderate fibrosis (HAI-F 0-2) and 31.8% (14) (HAI-F 3-4) had severe fibrosis to cirrhosis. These figures were 86.7% (13) and 13.3% (2) respectively in patients with low to moderate HBV DNA load.
The study shows that high HBV DNA load does not correlate with necro-inflammatory activity or extent of fibrosis in the liver in patients with either wild type or pre-core mutant type CHB.
孟加拉国位于乙型肝炎病毒（HBV）中度流行地区。在孟加拉国，感染HBV的终生风险超过40%。据估计，在孟加拉国，这种病毒导致10%-35%的急性病毒性肝炎病例、35.7%的暴发性肝衰竭病例、33.3%-40.5%的慢性肝炎病例以及46.8%的肝细胞癌病例。本研究的目的是比较慢性乙型肝炎（CHB）患者中HBV DNA载量与肝脏疾病分级和分期之间的相关性。
对159例CHB患者进行经皮肝活检，结果显示62.9%（100例）患者感染野生型HBV，其余37.1%（59例）患者感染前核心/核心启动子突变型HBV。所有患者均采用PCR法检测HBV DNA载量。
在野生型CHB组中，97%（97例）患者HBV DNA载量为中度至高度，3%（3例）患者为低度至中度。在前核心/核心启动子突变组中，74.6%（44例）患者HBV DNA载量为中度至高度，其余25.4%（15例）患者为低度至中度。野生型CHB患者中HBV DNA载量为中度至高度的患者，78.4%（76例）患有轻度至中度慢性肝炎（HAI-NI 0-8），21.6%（21例）患有中度至重度慢性肝炎（HAI-NI 9-18）。HBV DNA载量为低度至中度的患者中，66.6%（2例）和33.3%（1例）分别患有轻度至中度和中度至重度慢性肝炎。在HBV DNA载量为中度至高度的组中，77.3%（75例）患者有轻度至中度纤维化（HAI-F 0-2），22.7%（22例）（HAI-F 3-4）有重度纤维化至肝硬化。在HBV DNA载量为低度至中度的患者中，这些数字分别为33.3%（1例）和66.6%（2例）。另一方面，在前核心/核心启动子突变型CHB患者中，在HBV DNA载量为中度至高度的组中，79.5%（35例）患有轻度至中度慢性肝炎（HAI-NI 0-8），20.5%（9例）患有中度至重度慢性肝炎（HAI-NI 9-18）。HBV DNA载量为低度至中度的患者中，93.3%（14例）和6.7%（1例）分别患有轻度至中度和中度至重度慢性肝炎。在HBV DNA载量为中度至高度的组中，68.2%（30例）有轻度至中度纤维化（HAI-F 0-2），31.8%（14例）（HAI-F 3-4）有重度纤维化至肝硬化。在HBV DNA载量为低度至中度的患者中，这些数字分别为86.7%（13例）和13.3%（2例）。
该研究表明，野生型或前核心突变型CHB患者中，高HBV DNA载量与肝脏的坏死性炎症活动或纤维化程度无关。
