Clinical significance of low- level HBV DNA replication and specific antibody expression in patients with HBV- related liver failure

Objective To investigate the influential factors and clinical significance of low- level hepatitis B virus ( HBV) DNA replication and specific antibody expression in patients with HBV- related liver failure. Methods A retrospective analysis was performed on the medical records of 391 patients with HBV- related liver failure and 394 patients with chronic hepatitis B ( CHB) hospitalized in the Tianjin Second People's Hospital from June 2008 to December 2013. The HBV DNA level was compared between patients with HBV- related liver failure and those with CHB, and the influential factors were analyzed. According to the expression of HBV serum markers ( HBV- Ms) , patients with liver failure were divided into specific antibody- positive group ( positive for anti- HBs, anti- HBe or anti- HBc) and specific antibody- negative group ( negative for anti- HBs, anti- HBe or anti- HBc) . The changes in HBV DNA level and survival were compared between the two groups. Between- group comparison was made by independent- samples t test or Mann- Whitney rank sum test, and comparison of enumeration data was made by chi- square test. Results The patients with HBV- related liver failure had a significantly lower HBV DNA level than the CHB patients ( Z =- 16. 469, P < 0. 05) . The levels of HBV DNA in HBeAg- positive and- negative patients with liver failure were significantly lower than those in patients with CHB ( Z1=- 11. 665, P < 0. 05; Z2=- 12. 853, P < 0. 05) . Of the391 patients with HBV- related liver failure, 29 ( 7. 42%) were specific antibody- positive, and 25 ( 86. 21%) of them died; 362 ( 92. 58%) were specific antibody-negative, and 157 ( 43.37%) of them died. There was a significant difference in mortality between the specific antibody- positive and specific antibody- negative groups ( P < 0. 05) . The specific antibody- positive group had a significantly lower HBV DNA level than the specific antibody- negative group ( Z =- 3. 594, P < 0. 05) . For either group, the HBV DNA level was significantly lower in HBeAg- negative patients than in HBeAg- positive patients ( Z = 7. 427 or 7. 513, P < 0. 05) . Conclusion HBV M expression and the body's immune status play a role in the progression of HBV- related liver failure. HBV DNA replication is at a low level in the immune clearance phase. Being positive for anti- HBs, anti- HBe, and anti- HBc suggest a super immune response to HBV, leading to rapid progression of disease and high mortality.