慢性乙型肝炎抗病毒治疗HBeAg血清学转换的预测模型建立  

Establish a predictive modeling under antiviral therapy for hepatitis B e antigen seroconversion in chronic hepatitis B

作　　者：刘国旺[1] 唐克诚[1] 李谦[1] 陆伟[1,2] Liu Guowang;Tang Kecheng;Li Qian;Lu Wei(Department of Critical Liver Disease,Tianjin Second People＇s Hospital,Tianjin 300192,China;Tianjin First Central Hospital,Tianjin Institute of Hepatology,Tianjin 300192,China)

机构地区：[1]天津市第二人民医院重症肝病科,300192 [2]天津市第一中心医院天津市肝病医学研究所,300192

出　　处：《中华肝脏病杂志》2018年第9期641-645,共5页Chinese Journal of Hepatology

摘　　要：目的探讨影响慢性乙型肝炎HBeAg阳性初治患者抗病毒治疗过程中，HBeAg血清学转换的预测因素，并建立预测模型。方法收集HBeAg阳性慢性乙型肝炎患者198例。以脂肪肝、乙型肝炎家族史、年龄、性别、饮酒史、HBsAg、HBeAg、log10（HBVDNA）、总胆红素（TBil）、CD4／CD8、白蛋白、丙氨酸氨基转移酶（ALT）水平为HBeAg血清学转换的预测变量，观察患者抗病毒治疗144周HBeAg血清学转换情况。采用logistic回归分析HBeAg血清学转换的预测因素，并绘制受试者工作曲线（ROC）。结果198例患者HBeAg血清学转换率为36．87％。单因素分析显示：脂肪肝（χ2=35．377，P〈0．001）、乙型肝炎家族史（χ2=15．687，P〈0．001）、HBsAg（t=3．454，P〈0．001）、HBeAg（t=5．034，P〈0．001）、log10（HBVDNA）（z=4．651，P〈0．001）是HBeAg血清学转换的预测变量。经过多因素分析，乙型肝炎家族史、脂肪肝、log10（HBVDNA）、HBeAg是HBeAg血清学转换的独立预测因素。通过logistic回归分析建立回归模型Logit（P）=9．623—1．228×乙型肝炎家族史-1．726×脂肪肝-0．764×log10（HBVDNA）-0．146×HBeAg，ROC曲线下面积0．875。判断界值为-0．9350，其敏感性、特异性、准确率分别为92．70％、75．50％、83．22％。结论对于HBeAg阳性慢性乙型肝炎患者，乙型肝炎家族史、脂肪肝、log10（HBVDNA）、HBeAg可作为抗病毒治疗144周HBeAg血清学转换的独立预测因素。Objective To explore the predictive factors by demonstrating a predictive modeling under antiviral therapy for hepatitis B e antigen seroconversion in HBeAg-posifive chronic hepatitis B patients. Methods 198 cases with HBcAg-positive chronic hepatitis B were enrolled. Fatty liver, family history of hepatitis B, age, sex, drinking history, HBsAg, HBeAg, HBV-DNA levels, total bilirubin （TBil）, CD4/CD8, albumin （ALB）, alanine amino transferase （ALT） levels were used as a predictor variables of HBeAg seroconversion. Serological seroconversion of HBeAg was observed at 144 weeks of antiviral therapy. Predictive factors of HBeAg was analyzed by logistic regression analysis, and the receiver operating characteristic curve was plotted. Results HBeAg seroconversion rate was 36.87%. Univariate analysis demonstrated that fatty liver （χ2 = 35.377;P 〈 0.001）, family history of hepatitis B （χ2 = 15.687;P 〈 0.001）, the levels of HBeAg （t= 5.034;P 〈 0.001）, HBsAg （t = 3.454; P 〈 0.001） and HBV-DNA levels （χ2 = 4.651; P 〈 0.001） were predictor variables of HBeAgMultivariate analysis showed that family history of hepatitis B, fatty liver, HBV-DNA levels and HBeAg were independent predictors of HBeAg seroconversion. The established logistic regression model for HBeAg through regression analysis was logit P = 9.623-1.228 × family history of hepatitis B - 1.726 × fatty liver - 0.764 × HBV-DNA levels - 0.146 × HBeAg and area under curve was 0.875. When the cut-offvalue was -0.9350, the sensitivity and specificity were 92.70%, 75.50%, 83.22%, respectively. Conclusion Family history of hepatitis B, fatty liver, HBV-DNA levels and HBeAg may be independent predictors ofHBeAg seroconversion at 144 weeks of antiviral therapy in HBeAg-positive chronic hepatitis B patients.

关 键 词：肝炎病毒 乙型 回归分析 HBEAG血清学转换 预后模型 抗病毒治疗 

分 类 号：R512.62[医药卫生—内科学]