E抗原阴性的HBVER血中HBVDNA测定水平及意义

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The American Journal of Gastroenterology Volume 98, Issue 10 , October 2003, Pages 2261-2267 [B]Significance of hepatitis B viremia levels determined by a quantitative polymerase chain reaction assay in patients with hepatitis B e antigen–negative chronic hepatitis B virus infection [/B] Emanuel K. Manesis M.D.a, George V. Papatheodoridis M.D.a, Vasilios Sevastianos M.D, Evangelos Cholongitas M.D, Christos Papaioannou M.D and Stephanos J. Hadziyannis M.D., b a Academic Department of Medicine, Hippokration General Hospital, Athens, Greece b Department of Internal Medicine and Hepatology, Henry Dunant Hospital, Athens, Greece Received 12 September 2002; accepted 16 January 2003. ; Available online 15 October 2003. [B]Abstract[/B] [B]Objectives[/B] In hepatitis B e antigen (HBeAg)-negative chronic hepatitis B virus (HBV) infection, the clinical relevance of low viremia levels remains unclear. We evaluated the clinical significance of a single baseline serum HBV DNA measurement by a quantitative polymerase chain reaction (PCR) assay in this setting. [B]Methods[/B] In total, 196 patients with HBeAg-negative chronic HBV infection (62 inactive carriers, 134 with chronic hepatitis B) were studied. ALT activity was normal at baseline in 25/134 HBeAg-negative chronic hepatitis B patients (18.7%), whereas it remained normal throughout follow-up in all inactive carriers. [B]Results[/B] HBV DNA was <30,000 copies/ml in 14 (10.5%) and <100,000 copies/ml in 17 (12.9%) HBeAg-negative chronic hepatitis B patients, whereas it was <30,000 copies/ml in all inactive carriers (undetectable in 14). In particular, HBV DNA levels were <100,000 copies/ml in eight (32%) and <30,000 copies/ml in five (20%) of the 25 patients with HBeAg-negative chronic hepatitis B and normal baseline ALT values. HBV DNA levels with a cut-off at 30,000 or 100,000 copies/ml could correctly classify 92.9% or 91.3% of patients with HBeAg-negative chronic HBV infection, whereas ALT or IgM anti-HBc (IgM class antibody to HBV core antigen) index > 0.200 could correctly classify only 87.2% and 82.1% of patients, respectively. A combined HBV DNA and IgM anti-HBc index performed better by correctly classifying 94.4% of cases. [B]Conclusions[/B] Serum HBV DNA levels evaluated by sensitive quantitative PCR assays can be used for differentiation between HBeAg-negative chronic hepatitis B and inactive hepatitis B surface antigen carrier state, but the cut-off level should be set at approximately 30,000 copies/ml and certainly lower than the recently suggested level of 100,000 copies/ml.