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Clinical features of immune escape phase and immune control phase of chronic HBV infection
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摘要: 目的对慢性HBV感染者免疫控制期与免疫逃逸期的临床特征进行分析。方法选取2016年1月-2018年2月于延安大学附属医院门诊就诊或住院的"HBs Ag阳性、抗-HBe阳性、抗-HBc阳性"慢性HBV感染者226例,且均进行肝穿刺活组织检查。根据肝组织病理结果分为免疫控制期组[炎症活动度（A）<2且纤维化分期（F）<2者,121例]和免疫逃逸期组（A≥2或F≥2,105例）,比较分析两组患者的一般资料、病毒学、肝功能、肝硬度值（LSM）方面的差异。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验,计数资料两组间比较采用χ2检验。结果免疫控制期组与免疫逃逸期组在性别、年龄、乙型肝炎家庭聚集现象方面差异均无统计学意义（P值均>0.05）。两组患者的HBV DNA水平差异有统计学意义[1107. 00（369. 00～3876. 00） IU/ml vs 2171. 00（596. 00～8887. 00） IU/ml,Z=-2. 425,P=0. 015];但两组间HBs Ag和抗-HBc水平差异均无统计学意义（P值均> 0. 05）。免疫逃逸期...Abstract: 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.
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