Abstract: Objective To investigate the clinical significance of high-sensitive detection of HBV DNA,in combination with quantitative detection of hepatitis B surface antigen (HBsAg) and serum level of alanine aminotransferase (ALT) for chronic hepatitis B (CHB) viral infected patients.Methods Six hundred and fifty-four CHB patients were retrospectively analyzed for their clinical data and parameters including highly sensitive HBV DNA,HBsAg,hepatitis B e antigen (HBeAg),ALT,and Golgi protein 73 (GP73).The patients were divided into HBV DNA load <20,20~499,500~2 000,and >2 000 IU/mL groups based on a highly sensitive HBV DNA detection by real-time quantitative fluresence polymerase chain reaction.Results Among the 654 CHB patients,82.41% had HBV DNA<2 000 IU/mL and 65.29% had HBV DNA<500 IU/mL.Abnormal rates of ALT and GP73,positive rate of HBeAg and HBsAg were significantly different among the four groups (All P<0.05).HBsAg content was significantly different between the groups of <20 IU/mL,20~499 IU/mL and 500~2 000 IU/mL (all P<0.001).There was a significant curve correlation (P<0.001) between positive and highly sensitive HBV DNA viral load and ALT,GP73 and HBsAg levels,and the correlation coefficients R were 0.394,0.369 and 0.415,respectively.In HBeAg (-) patients,the abnormal rate of ALT in the HBV DNA 20~499 IU/mL group was significantly higher than that in the <20 IU/mL group (P=0.048).In HBeAg (+) patients,the abnormal rates of ALT and GP73 were not significantly different between these two groups (P=0.366,0.120).The HBV DNA positive rate,ALT abnormal rate and antiviral treatment duration of 427 patients with HBV DNA<500 IU/mL were significantly negatively correlated (P=0.001,<0.001).There was no significant trend correlation between the abnormal GP73 rate and the positive HBeAg rate and the treatment time (P=0.165,0.367).The abnormal rate of ALT in the untreated group was significantly different from that of the treatment duration of 1 to 2 years,2 to 3 years,and more than 3 years (P=0.023,0.009,0.001).There were statistically significant differences between the HBV DNA positive rate and the treatment duration of 2 to 3 years and >3 years in patients with abnormal ALT in the untreated group (P=0.028,0.010).Conclusion The combination of high-sensitivity HBV DNA detection with HBsAg quantification is more accurate in reflecting the viral replication status.For patients with HBV DNA<500 IU/mL under antiviral therapy,dynamic and high-sensitive monitoring of HBV DNA may help in controling liver damage caused by persistent low-level of viral replication,which is of great significance for guiding clinical treatment and prognosis.

Key words: highly sensitive HBV DNA, HBsAg, HBeAg, ALT.GP73