217例HBsAg携带者16年临床观察

作者	单位
李福山	第一军医大学南方医院放疗科
陈龙华	第一军医大学南方医院放疗科
汤习锋	第一军医大学南方医院检验科
闫卫平	第一军医大学南方医院放疗科
林树强	广东省潮州市中心医院传染科
杨忠伟	广东省台山市中医院医务科

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中文摘要:

目的观察HBsAg无症状携带者 (AsC)临床经过 ,探讨慢性乙型肝炎 (CHB)、肝硬化 (LC)、肝细胞癌 (HCC)临床演变规律 ,寻求有效阻断方法。方法从健康人群查体中选择AsC ,以全国病毒性肝炎防治方案诊断标准为依据 ,定期与不定期进行肝病常规检查 ,剔除HCV混合感染 ,对HBV感染系列完成 16年临床经过观察。结果 2 17例AsC 16年间HBsAg转阴 2 1例 (9 6 8% ) ,平均年转阴率为 0 5 8% ,其中6 1 9% (13/ 2 1例 )产生抗 HBs,2 0例属临床治愈 ,1例转化为HCC。 5 7 14 % (12 4 / 2 17例 )仍保持无症状携带者状态 ,73例转化为慢性肝病 ,呈CHB、LC、HCC逐渐演变趋势 ,每年AsC向LC、HCC的转化率分别为1 0 4 %、0 4 0 %。因肝病死亡 15例 ,其中死于CHB(重度 ) 1例 ,LC 3例 ,HCC 11例。结论随着年龄增长和机体对HBV免疫应答调节不同 ,可表现不同临床转归。HBeAg阳性 (e+)HCC与LC患者相对较少 ,常表现为HBeAg阴性 (e- )或抗 HBe阳性。用中西医结合肝病分型观察AsC演变CHB、LC及HCC的临床特征 ,认为血瘀征象程度与肝病发展相一致

英文摘要:

Objective By means of observing the clinical development of asymptomatic chronic HBsAg carriers (AsC) to explore the clinical rule of development of chronic hepatitis B (CHB) to liver cirrhosis (LC) to hepatocellular carcinoma (HCC) and to seek effective method for blocking the procedure. Methods AsCs were selected from health examination according to the diagnostic standard from the National Program for Prevention and Treatment of Viral Hepatitis, by periodical or non periodical conventional examination of liver diseases, mixed infection of HCV was excluded. A 16 year systematic observation on clinical process of HBV infection series was completed. Results In the 217 AsCs observed, 21 cases (9.68%) with the HBsAg negatively converted, the average year negative conversion rate being 0.58%, among them, 13/21 cases (61.9%) had production of anti HBs antigen; 20 cases were clinically cured; 1 case transferred to HCC; 124 cases (57.14%) remained asymptomatic carriers; 73 transferred to chronic liver disease, showing a tendency of gradually developing from CHB to LC to HCC, the year transferring rate from AsC to LC and HCC being 1.04% and 0.40%, respectively. Fifteen patients died of liver diseases, in which one died of severe CHB, 3 of LC and 11 of HCC. Conclusion Different clinical end results may reveal in AsCs according to their age and regulation on immune response to HBV. Few of the HCC and LC patients were HBeAg (e+) positive, they often reveal HBeAg(e -) negative or anti HBe positive. HCC always develops on the basis of liver fibrosis or cirrhosis, which are the prophase of HCC, and patients with liver fibrosis or cirrhosis are the high risk group of developing HCC. HCC is not only the terminal pathologic stage of hepatopathy, but also one of the most important factors that causes death of chronic hepatopathy. From the viewpoint of integrative medicine in typing hepatopathy to observe the clinical speciality of AsC developing to CHB, LC and HCC, it is considered that the degree of blood stasis is in accordance with the development of hepatopathy.

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