经核苷(酸)类药物治疗的慢性乙型肝炎HBsAg定量分析  

Kinetics of serum HBsAg in chronic hepatitis B patients with nucleos(t) ide analogues treatment

作　　者：张梦阳[1] 叶素素[1] 刘晓清[1] 许少侠[2] 周宝桐[1] 侍效春[1] 徐虹[3] 韩扬[1] 张丽帆[1] 邓国华[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院感染内科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院检验科,北京100730 [3]中国医学科学院北京协和医学院北京协和医院门诊部,北京100730

出　　处：《基础医学与临床》2017年第6期817-820,共4页Basic and Clinical Medicine

基　　金：北京市科技计划(D121100003912003);中国医疗手牵手工程委员会;北京医学奖励基金项目(YJHKXKYJJ-244);中国乙肝随访与临床科研平台项目(CR-HepB)

摘　　要：目的总结分析慢性乙型肝炎(CHB)患者使用核苷(酸)类药物(NAs)进行抗病毒治疗后,HBsAg水平的动态变化规律。方法回顾性收集2012年7月30日至2016年12月30日在北京协和医院进行血清乙型肝炎表面抗原定量(qHBsAg)检测的CHB患者资料,分析随访192周过程中每24周的qHBsAg、HBV DNA和HBeAg的数据。采用化学发光微粒子免疫分析法检测qHBsAg和HBeAg,采用PCR和COBAS Amplicor检测HBV DNA。结果共纳入60例患者,HBeAg阳性组基线HBV DNA高于阴性组(P<0.05),在48周后均降至检测下限以下。HBeAg阳性组与HBeAg阴性组基线qHBsAg分别为(3.43±0.73)log_(10)IU/m L,(3.08±0.47)log_(10)IU/m L。除48周外,所有随访时间点HBeAg阳性组qHBsAg均高于HBeAg阴性组(P<0.05)。HBeAg阳性组在抗病毒治疗后,HBeAg定量有显著下降(P<0.05)。结论 CHB患者在接受长期NAs治疗过程中,实现HBsAg转阴这一临床治愈目标较为困难,长期应用NAs治疗十分必要。Objective To summarize and analyze the dynamic change of HBsAg levels in patients with chronic Hepatitis B （CHB） after receiving nucleos（t）ide analogues （NAs） as antiviral treatment. Methods Patients who were performed quantitative Hepatitis B surface antigen（qHBsAg） from July 30, 2012 to December 30,2016 in Peking Union Medical College Hospital were retrospectively enrolled, qHBsAg, HBV DNA, HBeAg were collected and analyzed at baseline and at 192-week follow-up every 24 weeks, qHBsAg and HBeAg were assessed with chemiluminesent micropartiele immuno assay（CMIA）. HBV DNA was assessed with PCR and COBAS Amplicor. Results 60 patients were included. Patients in HBeAg-positive group had higher HBV DNA than that in HBeAg- negative group （ P 〈 0. 05 ） at baseline and the two groups both were under detection limit after 48 weeks. Baseline qHBsAg in HBeAg positive-group and negative-group were （ 3.43± 0.73 ） log10 IU/mL, （ 3.08 ±0.47 ） log10 IU/mL respectively, qHBsAg in HBeAg-positive group was higher than that in HBeAg negative-group on all fol- low-ups（P 〈 0.05） except d8weeks. However on 168 weeks and 192 weeks, difference between the two groups was statistically significant （ P 〈0. 05 ）. In HBeAg-positive group, quantitative HBeAg dropped significantly during antiviral treatment. Conclusions HBV replication can be suppressed in the process of long-term NAs treatment in CHB patients. However qHBsAg decline is not so obvious, which indicates that HBsAg cleavence is difficult, and long-term NAs therapy is still necessary.

关 键 词：慢性乙型肝炎 核苷(酸)类药物 表面抗原定量 

分 类 号：R512.62[医药卫生—内科学]