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目的对乙型肝炎病毒 e 抗原(HBeAg)阴性及 HBeAg 阳性乙型肝炎肝硬化患者的临床特征及预后进行对照研究。方法观察217例乙型肝炎肝硬化患者35个月(3～47个月),对HBeAg 阴性及 HBeAg 阳性乙型肝炎肝硬化患者的临床特征及预后进行对照研究。结果在所观察人群中,HBeAg 阴性乙型肝炎肝硬化多于 HBeAg 阳性乙型肝炎肝硬化;HBeAg 阴性患者的中位丙氨酸转氨酶及天冬氨酸转氨酶水平低于 HBeAg 阳性患者;HBeAg 阴性患者中位白细胞,血红蛋白及血小板水平低于 HBeAg 阳性患者;HBeAg 阴性患者中 HBV DNA 阳性率及 HBV DNA>10~5拷贝/ml患者比例低于 HBeAg 阳性患者;HBeAg 阴性乙型肝炎肝硬化患者病死率高于 HBeAg 阳性乙型肝炎肝硬化患者;在 HBeAg 阴性患者组,口服拉米夫定进行抗病毒治疗者腹水、出血及肝癌的发生率低于未抗病毒治疗者。抗病毒治疗患者在整个研究期间未出现肝硬化相关并发症的患者比例高于未抗病毒治疗患者,而出现1～2个并发症的患者比例低于未抗病毒治疗患者;在 HBeAg 阳性患者组,口服拉米夫定进行抗病毒治疗者腹水的发生率低于未抗病毒治疗者,抗病毒治疗患者在整个研究期间未出现肝硬化相关并发症的患者比例高于未抗病毒治疗患者。结论 HBeAg 阴性肝硬化患者其生化指标,外周血细胞计数,HBV DNA 载量等均低于 HBeAg 阳性组。HBeAg 阴性肝硬化患者病死率高于HBeAg 阳性组。
Objective To compare the clinical characteristics and prognosis of patients with hepatitis B virus e antigen (HBeAg) negative and HBeAg-positive hepatitis B cirrhosis. Methods A total of 217 patients with hepatitis B cirrhosis were observed for 35 months (range 3 to 47 months). The clinical characteristics and prognosis of patients with HBeAg-negative and HBeAg-positive hepatitis B cirrhosis were observed. Results Among the observed population, there were more cirrhosis of HBeAg-negative hepatitis B than HBeAg-positive hepatitis B cirrhosis. The levels of alanine aminotransferase and aspartate aminotransferase in HBeAg-negative patients were lower than those in HBeAg-negative patients. The median level of white blood cells, hemoglobin and platelet were lower than that of HBeAg-positive patients; the positive rate of HBV DNA and the percentage of HBV DNA> 10 ~ 5 copies / ml in HBeAg-negative patients were lower than those in HBeAg-positive patients; the mortality of patients with HBeAg-negative hepatitis B cirrhosis Higher than HBeAg-positive patients with hepatitis B cirrhosis; in HBeAg-negative patients, the incidence of ascites, hemorrhage and liver cancer was lower in patients with HBeAg-negative than those without antiviral therapy. The proportion of patients with antiviral therapy that did not develop cirrhosis-related complications over the entire study period was higher than those who did not have antiviral therapy, whereas those with one or two complications were lower than those without antiviral therapy. In HBeAg-positive patients , The incidence of ascites in patients receiving antiviral therapy with oral lamivudine was lower than those without antiviral therapy, and the proportion of patients with antiviral therapy who did not have cirrhosis-related complications during the entire study was higher than those without antiviral therapy. Conclusion The biochemical indexes, peripheral blood cell count and HBV DNA load of patients with HBeAg-negative cirrhosis are lower than those of HBeAg-positive patients. The mortality of patients with HBeAg-negative cirrhosis was higher than that of HBeAg-positive patients.