0326临检中心-张欣欣.pdf

如何解读肝炎病毒核酸 定量检测结果 瑞金医院 感染科 张欣欣 乙型肝炎病毒核酸 HBV DNA Prevalence of HBsAg in China Sero-epidemiological Survey 2006  81,775 persons surveyed in 160 registries in 31 provinces; HBsAg prevalence: 7.18% (9.72% in 1992) Liang XF et al. Vaccine, 2009,6550-6557 HBV 基因组 Hunt et al. Hepatology 2000; 31: 1037. 乙型肝炎实验室诊断 Markers of the virus Antibodies to the virus  HBV DNA  Anti-HBc, Anti-HBc-IgM  HBeAg  Anti-HBe  HBsAg  Anti-HBs  cccDNA Severity of liver damage Markers of liver damage  Bilirubin  ALT  Albumin  AST  Prothrombin time  Bilirubin 5 HBV DNA定量的临床意义  病毒复制的指标  长期感染临床转归预测  抗病毒治疗指征  抗病毒治疗应答评估，及时调整治疗方案  隐匿性乙肝病毒感染的诊断  病毒变异的提示 慢性HBV 感染自然过程 Immune Immune Low Replicative Reactivation Tolerance Clearance Phase Phase HBeAg+ HBeAg-/anti-HBe+ (precore/core promoter variants) 2000 IU/mL HBV DNA 2000 IU/mL 2 x 108 - 2 x 1011 IU/mL 200,000 - 2 x 109 IU/mL ALT Normal/mild Moderate/severe CH Normal/mild CH Moderate/severe CH CH