Analysis of liver damage and reactivation of hepatitis B virus in hepatitis B surface antigen positive patients after extremely severe burn injury
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摘要: 目的 分析HBsAg阳性特重度烧伤患者治疗过程中肝功能损害及乙型肝炎病毒(HBV)再激活情况,为HBV感染特重度烧伤患者肝功能损害的防治提供参考。 方法 对2004年1月–2014年12月笔者单位收治的54例HBsAg阳性特重度烧伤患者的病历资料进行回顾性分析。根据患者性别、入院时乙型肝炎e抗原(HBeAg)情况、入院时HBV DNA情况、治疗过程中是否并发脓毒症进行分类,统计患者治疗过程中是否发生肝功能损害或者HBV再激活。对数据行
χ 2检验。 结果 (1)患者治疗过程中肝功能损害发生率高达85.2%(46/54)。男性患者发生肝功能损害的比例为35/38,显著高于女性患者的11/16,χ 2=4.867,P <0.05。26例入院时HBeAg阳性患者、34例入院时HBV DNA阳性患者、36例治疗过程中并发脓毒症患者均发生肝功能损害,比例显著高于入院时HBeAg阴性患者、入院时HBV DNA阴性患者、治疗过程中未并发脓毒症患者的20/28、12/20、10/18,χ 2值分别为11.801、18.384、20.574,P 值均小于0.01。(2)患者治疗过程中HBV再激活发生率为29.6%(16/54)。男性患者发生HBV再激活的比例为13/38,女性患者发生HBV再激活的比例为3/16,两者比较差异无统计学意义(χ 2=0.656,P >0.05)。入院时HBeAg阳性患者、入院时HBV DNA阳性患者、治疗过程中并发脓毒症患者发生HBV再激活的比例分别为13/26、16/34、15/36,显著高于入院时HBeAg阴性患者、入院时HBV DNA阴性患者、治疗过程中未并发脓毒症患者的3/28、0/20、1/18,χ 2值分别为9.979、18.615、5.873,P <0.05或P <0.01。 结论 入院时HBsAg、HBeAg、HBV DNA阳性及治疗过程中并发脓毒症的特重度烧伤患者极易发生肝功能损害,HBV再激活风险较高,治疗中应动态监测HBV DNA和肝功能变化,及时了解病毒再激活情况。Abstract: Objective To analyze the development of liver damage and reactivation of hepatitis B virus (HBV) during the treatment of extremely severe burn injury in HBsAg positive patients, in order to provide reference for prevention and treatment of liver damage in patients with HBV infection after extremely severe burn. Methods Medical records of 54 HBsAg positive patients after extremely severe burn injury admitted from January 2004 to December 2014 were retrospectively analyzed. Development of liver damage and HBV reactivation of these patients during the treatment were analyzed according to the classification of their gender, results of hepatitis B e antigen (HBeAg) and HBV DNA examinations on admission, and development of sepsis in the process of treatment. Data were processed with chi-square test. Results (1) The incidence of liver damage in the process of treatment of these patients was 85.2% (46/54). Among all the patients, the proportion of liver damage was 35/38 in male, which was significantly higher than that in female (11/16,χ 2=4.867,P <0.05). Liver damage was found in all of 26 patients who were HBeAg positive on admission, 34 patients who were HBV DNA positive on admission, and 36 patients who developed sepsis in the process of treatment; the proportions were significantly higher than those in patients who were HBeAg negative on admission (20/28), patients who were HBV DNA negative on admission (12/20), and patients who did not develop sepsis in the process of treatment (10/18), withχ 2 values respectively 11.801, 18.384, and 20.574,P values below 0.01. (2) The incidence of HBV reactivation in these patients was 29.6% (16/54). Among all the patients, the proportion of HBV reactivation was 13/38 in male and 3/16 in female, with no statistically significant difference between them (χ 2=0.656,P >0.05). The proportions of HBV reactivation in patients who were HBeAg positive on admission, patients who were HBV DNA positive on admission, and patients who developed sepsis in the process of treatment were respectively 13/26, 16/34, and 15/36, and they were significantly higher than those in patients who were HBeAg negative on admission (3/28), patients who were HBV DNA negative on admission (0/20), and patients who did not develop sepsis in the process of treatment (1/18), withχ 2 values respectively 9.979, 18.615, and 5.873,P <0.05 orP <0.01. Conclusions Patients who are HBsAg positive, HBeAg positive, HBV DNA positive on admission, and develop sepsis in the process of treatment of extremely severe burn injury are more likely to develop liver damage and HBV reactivation. It is necessary to dynamically monitor the changes in HBV DNA and liver function, in order to identity the reactivation of virus.-
Key words:
- Burns /
- Immune tolerance /
- Hepatitis B virus /
- Liver damage /
- Virus reactivation
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