摘要目的 监测核苷类似物治疗慢性乙犁肝炎(CHB)的过程中HBsAg及HBV DNA水平的动态变化,并探讨HBsAg滴度与HBV DNA复制水平的相关性.方法 选取57例拉米夫定(LAM)、20例阿德福韦(ADV)抗病毒治疗2年以及23例未使用核苷类似物治疗的CHB患者,所有患者均未进行其它抗病毒药物治疗.于不同时间点采集血清标本,动态监测HBsAg及HBV DNA水平,并分析两者之间的相关性.结果 (1)57例LAM抗病毒治疗的CHB患者中,20例有效应答后出现病毒反弹的患者,在HBV DNA发生剧烈变化的4个时间点.未观察到HBsAg滴度随HBV DNA复制水平的一致变化,无相关性(P>0.05);37例应答良好的患者,可观察到HBsAg水平随HBV DNA复制水平的一致变化,呈正相关(r=0.71,P<0.05).(2)20例ADV抗病毒治疗的CHB患者中,7例有效应答后出现病毒反弹的患者,未观察到HBsAg随HBV DNA水平的一致变化,无相关性(P>0.05);13例应答良好的患者,可观察到HBsAg随HBV DNA复制水平的一致变化,呈正相关(r=0.73,P<0.05).结论 核苷类似物治疗CHB的过程中,对核苷类似物抗病毒治疗有良好应答的患者,HBsAg滴度在一定程度上能反映HBV DNA复制水平,HBsAg滴度与HBV DNA复制水平有相关性.

abstractsObjective To investigate the correlation between hepatitis B surface antigen (HBsAg) level and hepatitis B virus (HBV) DNA replication level in chronic hepatitis B (CHB) patients treated with nucleoside analogues. Methods Of 100 CHB patients, 57 were treated with lamivudine for 2 years, 20 with adefovir dipivoxil for 2 years and 23 were nucleoside-naive. Any other antiviral medication was not performed in all patients. Serum samples were collected at different time points. HBV DNA was measured with real-time polymerase chain reaction (PCR) and HBsAg was quantified with an automated chemiluminescent microparticle immunoassay. Correlation between HBV DNA and HBsAg were analyzed. Results (1)Among the 57 lamivudine-treated CHB patients, 20 who showed viral rebound after a good response were found with drastic changes in HBV DNA level at 4 time points not accompanied by correlated trends in HBsAg (P>0.05), and 37 who maintained a good response throughout the study were found with positively correlated changes in HBsAg and HBV DNA level (r=0.71, P< 0.05). (2) In the 20 adefovir-treated patients, correlated changes in HBV DNA duplication level and HBsAg were observed in 13 patients who maintained a good response throughout the study (r=0.73, P<0.05) but not in the other 7 who showed viral rebound after a good response (P>0.05). Conclusion During nucleoside analogue treatment of CHB, HBsAg titer may somewhat reflex the HBV DNA duplication level with good correlation among those who respond well to the therapy.