【摘要】 目的探讨HBV与EB病毒(EBV)重叠感染在HBV相关性肝病[慢性乙型肝炎(CHB)、肝硬化、肝细胞癌(HCC)]中的意义。方法对2016年5月-2018年8月在武汉大学中南医院确诊的487例HBV感染者的临床资料进行回顾性分析,合并EBV感染者194例(39. 8%)。分别按照EBV DNA拷贝数(≥400 IU/ml)、肝功能Child-Pugh分级(A、B、C级)及肝病进程分组(CHB组、肝硬化组、HCC组),比较组间的临床指标差异。正态分布的计量资料2组间比较采用t检验,多组间比较采用方差分析,进一步两两比较采用LSD-t检验;非正态分布的计量资料多组间比较采用Kruskal-Wallis H非参数检验,进一步两两比较采用DunnBonferroni检验;计数资料组间比较采用χ~2检验。结果 HBV DNA拷贝数在CHB组患者中高于肝硬化和HCC患者,差异均有统计学意义(t=2. 417,P=0. 017; t=3. 258,P=0. 001),而EBV DNA拷贝数在HCC患者中有高于CHB和肝硬化患者的趋势,但3组间差异无统计学意义(F=1. 161,P=0. 315); Child-Pugh分级排除肝功能影响后,A级患者HCC组EBV DNA拷贝数高于CHB和肝硬化组(t=2. 062,P=0. 041; t=2. 615,P=0. 010),C级患者肝硬化组EBV DNA拷贝数高于CHB组(t=2. 647,P=0. 072)。双重感染特异性临床变化指标有ALT/AST、Glb、淋巴细胞百分数。结论 HCC患者EBV载量升高,可能与HBV共同参与了肝脏疾病的进展,动态定量检测HBV感染者EBV DNA对早期干预肝病进展有一定指导意义。更多还原

【Abstract】 Objective To investigate the clinical significance of co-infection with hepatitis B virus( HBV) and Epstein-Barr virus( EBV) in HBV-related liver diseases such as chronic hepatitis B( CHB),liver cirrhosis,and hepatocellular carcinoma( HCC). Methods A retrospective analysis was performed for the clinical data of 487 patients with HBV infection who were diagnosed in Zhongnan Hospital of Wuhan University from May 2016 to August 2018,among whom 194( 39. 8%) had co-infection with HBV and EBV. The patients were divided into groups according to the copy number of EBV DNA( > 400 IU/ml),Child-Pugh class( Child-Pugh class A,B,and C),and progression of liver disease( CHB,liver cirrhosis,and HCC),and related indices were compared between groups. The t-test was used for comparison of normally distributed continuous data between two groups; an analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups,and the Dunn-Bonferroni test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. Results The patients with CHB had a significantly higher copy number of HBV-DNA than those with liver cirrhosis or HCC( t = 2. 417 and 3. 258,P = 0. 017 and 0. 001),while the patients with HCC tended to have a higher copy number of EBV DNA than those with CHB or liver cirrhosis,but there was no significant difference between the three groups( F = 1. 161,P = 0. 315). After adjustment for liver function based on Child-Pugh class,the HCC patients with Child-Pugh class A liver function had a significantly higher copy number of EBV DNA than the CHB patients and the patients with liver cirrhosis( t = 2. 062 and 2. 615,P = 0. 041 and 0. 010),the liver cirrhosis patients with Child-Pugh class C liver function had a significantly higher copy number of EBV DNA than the CHB patients( t = 2. 647,P = 0. 012). ALT/AST,globulin,and lymphocyte percentage were specific clinical indices for co-infection with HBV and EBV. Conclusion There is an increase in EBV load in HCC patients,and both EBV and HBV are involved in the progression of liver diseases. Dynamic quantification of EBV DNA in patients with HBV infection has a certain significance in early intervention of the progression of liver diseases.更多还原