Fan Rong, Yin Jun-Hua, Yang Shu-Ling, Li Xiao-Xi, Yu Gao-Yang, Sun Jian, Hou Jin-Lin
Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2012 Mar;32(3):354-7.
To investigate the short-term spontaneous fluctuation of viral load in patients with chronic hepatitis B (CHB) and explore the related factors in treatment naive CHB patients during immune clearance phase.
A total of 123 treatment naive HBeAg-positive CHB patients with ALT>2 × ULN were enrolled in this study. Paired serum samples were obtained at the first and second visits with an interval of less than 4 weeks. The levels of quantitative HBV DNA (Roche COBAS), quantitative HBsAg, ALT and AST were analyzed. Liver biopsy specimen were collected within 4 weeks and evaluated using Knodell and Ishak histological scoring system.
Of the 123 patients, 93 (75.6%) and 30 (24.4%) had HBV DNA fluctuation ≤ 0.5 Log IU/ml and >0.5 Log IU/ml, respectively. Binary logistic multivariate regression analysis identified Knodell necroinflammation score and HBV DNA level as the factors related to HBV DNA fluctuation. Patients with Knodell necorinflammation score ≥ 10 or HBV DNA<7 Log IU/ml had significantly higher rates of HBV DNA fluctuation>0.5 Log IU/ml (50.0% vs 18.3%, P=0.042; 42.9% vs 20.6%, P=0.030).
Treatment naive CHB patients in immune clearance phase show short-term spontaneous fluctuation of HBV DNA, and nearly 25% of the patients have HBV DNA fluctuation >0.5 Log IU/ml. Such fluctuation is related to liver inflammation and quantity of HBV DNA.
研究慢性乙型肝炎（CHB）患者病毒载量的短期自发波动情况，并探讨初治CHB患者免疫清除期的相关因素。
本研究共纳入123例ALT>2×ULN的初治HBeAg阳性CHB患者。在首次和第二次就诊时采集配对血清样本，间隔时间少于4周。分析定量HBV DNA（罗氏COBAS）、定量HBsAg、ALT和AST水平。在4周内收集肝活检标本，并使用Knodell和Ishak组织学评分系统进行评估。
123例患者中，93例（75.6%）和30例（24.4%）的HBV DNA波动≤0.5 Log IU/ml和>0.5 Log IU/ml。二元逻辑多变量回归分析确定Knodell坏死炎症评分和HBV DNA水平为与HBV DNA波动相关的因素。Knodell坏死炎症评分≥10或HBV DNA<7 Log IU/ml的患者，其HBV DNA波动>0.5 Log IU/ml的发生率显著更高（50.0%对18.3%，P=0.042；42.9%对20.6%，P=0.030）。
免疫清除期初治CHB患者的HBV DNA呈现短期自发波动，近25%的患者HBV DNA波动>0.5 Log IU/ml。这种波动与肝脏炎症和HBV DNA数量有关。
