Abstract: Objective　To analyze the effect of serum hepatitis B virus（HBV）-DNA load on liver function and endoplasmic reticulum stress（ERS）in peripheral blood in patients with hepatitis B，so as to provide evidence for clinical diagnosis and treatment of HBV.Methods　A total of 136 cases of patients with hepatitis B admitted to Tangshan Infectious Disease Hospital from July 2016 to June 2017 were enrolled and were divided into negative group（serum HBV-DNA load <1.0×103 copies/ml），low copy group（1.0×103 copies/ml≤ Serum HBV-DNA load <1.0×105 copies/ml），medium copy group（1.0×105 copies/ml≤ Serum HBV-DNA load <1.0×107 copies/ml），and high copy group（serum HBV-DNA load ≥1.0×107 copies/ml）.A total of 82 non-HBV infection patients admitted to Tangshan Infectious Disease Hospital were selected as the control group.Serum HBV-DNA load，liver function indexes〔alanine aminotransferase（ALT），aspartic acid aminotransferase（AST），Gamma transglutaminase（γ-GT），alkaline phosphatase（ALP）〕，ERS-related indexes〔glucose regulation protein（GRP78），CCAAT/-enhanced protein（CHOP）and cysteine aspartyl-specific protease-12（caspase-12）〕were detected and compared in 5 groups.The correlation of liver function index with serum HBV-DNA load and ERS-related indexes was analyzed.Results　There was no significant difference in ALP in 5 groups（P>0.05）.ALT and AST in low copy group，medium copy group and high copy group were higher than those in control group and negative group（P<0.05）.ALT and AST in medium copy group and high copy group were higher than those in low copy group（P<0.05）.ALT and AST in high copy group were higher than those in medium copy group（P<0.05）.γ-GT in negative group，low copy group，medium copy group and high copy group was higher than that in the control group（P<0.05）.GRP78，CHOP，caspase-12 in negative group，low copy group，medium copy group and high copy group were higher than those in control group（P<0.05）.GRP78 in low copy group was lower than that in negative group（P<0.05），and GRP78 in medium copy group was higher than that in low copy group（P<0.05）.ALT and AST were positively correlated with serum HBV-DNA load（P<0.05），γ-GT and ALP had no linear correlation with serum HBV-DNA load（P>0.05）.There was no linear correlation between ALT，AST，γ-GT，ALP and GRP78，CHOP and caspase-12（P>0.05）.Conclusion　The serum HBV-DNA load in patients with hepatitis B can affect the liver function and induce ERS in peripheral blood，which has a certain practical guiding significance for pathogenesis，clinical diagnosis and treatment of hepatitis B.

Key words: Hepatitis B, Hepatitis B virus, Endoplasmic reticulum stress, Liver function

摘要： 目的　分析血清乙型肝炎病毒（HBV）-DNA载量对乙型肝炎（以下简称乙肝）患者肝功能及外周血内质网应激（ERS）相关指标的影响，为乙肝的临床诊治提供依据。方法　选取2016年7月—2017年6月在唐山市传染病医院治疗的乙肝患者136例。按血清HBV-DNA载量将患者分为阴性组（血清HBV-DNA载量<1.0×103 copies/ml）、低拷贝组（1.0×103 copies/ml≤血清HBV-DNA载量<1.0×105 copies/ml）、中拷贝组（1.0×105 copies/ml≤血清HBV-DNA载量<1.0×107 copies/ml）、高拷贝组（血清HBV-DNA载量≥1.0×107 copies/ml）。同期选取在唐山市传染病医院治疗的非HBV感染患者82例为对照组。检测并比较5组血清HBV-DNA载量、肝功能指标〔丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转肽酶（γ-GT）、碱性磷酸酶（ALP）〕、ERS相关指标〔葡萄糖调节蛋白78（GRP78）、CCAAT/增强子结合蛋白（CHOP）、天冬半胱氨酸特异性蛋白酶-12（caspase-12）〕，分析肝功能指标与血清HBV-DNA载量及ERS相关指标的相关性。结果　5组ALP比较，差异无统计学意义（P>0.05）；低拷贝组、中拷贝组、高拷贝组ALT、AST高于对照组、阴性组（P<0.05）；中拷贝组、高拷贝组ALT、AST高于低拷贝组（P<0.05）；高拷贝组ALT、AST高于中拷贝组（P<0.05）；阴性组、低拷贝组、中拷贝组、高拷贝组γ-GT高于对照组（P<0.05）。阴性组、低拷贝组、中拷贝组、高拷贝组GRP78、CHOP、caspase-12高于对照组（P<0.05）；低拷贝组GRP78低于阴性组（P<0.05）；中拷贝组GRP78高于低拷贝组（P<0.05）。ALT、AST与血清HBV-DNA载量均呈正相关（P<0.05）；γ-GT、ALP与血清HBV-DNA载量无直线相关关系（P>0.05）。ALT、AST、γ-GT、ALP与GRP78、CHOP、caspase-12均无直线相关关系（P>0.05）。结论　乙肝患者血清HBV-DNA载量可对肝功能产生影响，且可诱发外周血ERS，这对乙肝的发病机制研究及临床诊治有一定的现实指导意义。

关键词: 乙型肝炎, 乙型肝炎病毒, 内质网应激, 肝功能