血清乙型肝炎病毒RNA对丙氨酸转氨酶正常或轻度升高的慢性乙型肝炎患者显著性炎症的诊断价值  

Diagnostic value of serum hepatitis B virus RNA levels on liver significant inflammation of chronic hepatitis B patients with normal or mildly elevated alanine transaminase levels

作　　者：黄晨璐 戚勋[1] 许伟[1] 胡乾坤 张小楠 李强[1] 黄玉仙[1] 陈良[1] Huang Chenlu;Qi Xun;Xu Wei;Hu Qiankun;Zhang Xiaonan;Li Qiang;Huang Yuxian;Chen Liang(Department of Liver Diseases,Shanghai Public Health Clinical Center,Fudan University,Shanghai 201508,China;Research Unit,Shanghai Public Health Clinical Center,Fudan University,Shanghai 201508,China)

机构地区：[1]复旦大学附属公共卫生临床中心肝病科,上海201508 [2]复旦大学附属公共卫生临床中心科研中心,上海201508

出　　处：《中华传染病杂志》2020年第9期569-574,共6页Chinese Journal of Infectious Diseases

基　　金：上海市科学技术委员会医学引导类科技支撑项目(17411969700);上海申康医院发展中心市级医院新兴前沿技术联合攻关项目(SHDC12015129)。

摘　　要：目的探讨丙氨酸转氨酶(alanine transaminase,ALT)正常或轻度升高的慢性乙型肝炎(chronic hepatitis B,CHB)患者血清乙型肝炎病毒(hepatitis B virus,HBV)RNA与肝脏炎症程度的相关性及其对肝脏显著性炎症的诊断价值。方法采用回顾性分析,纳入2016年1月至2019年6月复旦大学附属公共卫生临床中心收治的221例ALT<2倍正常值上限的CHB初治患者,所有患者均进行肝脏病理学检查。采用反转录定量聚合酶链反应检测血清HBV RNA水平。统计学分析采用t检验、Mann-Whitney U检验、χ2检验、logistic回归分析。结果乙型肝炎e抗原(hepatitis B e antigen,HBeAg)阳性患者83例,其血清HBV RNA随着炎症程度的升高而下降[(6.208±1.363)lg拷贝/mL比(4.654±0.962)lg拷贝/mL],HBeAg阴性患者138例,其血清HBV RNA随着炎症程度的升高而升高[(3.101±0.720)lg拷贝/mL比(3.965±0.782)lg拷贝/mL],差异均有统计学意义(t=6.035、-5.892,均P<0.01)。logistic回归分析显示,HBV RNA是HBeAg阳性患者肝脏显著性炎症的独立预测因素[比值比(odds ratio,OR)=0.168,P=0.003]。HBV RNA的受试者操作特征曲线下面积(area under receiver operator characteristic curve,AUROC)为0.82[95%可信区间(confidence interval,CI)0.73~0.91],ALT的AUROC为0.56(95%CI 0.44~0.69),差异有统计学意义(z=2.975,P=0.003)。HBV RNA(OR=4.960,P<0.01)、γ-谷氨酰转肽酶(OR=1.021,P=0.019)和血小板计数(OR=0.987,P=0.008)均是HBeAg阴性患者肝脏显著性炎症的独立预测因素。HBeAg阴性患者HBV RNA的AUROC为0.78(95%CI0.69~0.87),ALT的AUROC为0.65(95%CI 0.55~0.75),血清HBV RNA、γ-谷氨酰转肽酶和血小板计数3项指标联合诊断模型的AUROC为0.86(95%CI 0.79~0.93)。结论血清HBV RNA水平在ALT正常或轻度升高的初治CHB患者肝脏不同炎症阶段存在差异,与炎症进展程度相关的血清HBV RNA和联合诊断模型可以作为新型无创生物学炎症标志物指导ALT正常或轻度升高CHB初治患者用药。Objective To investigate the relationship and diagnostic value of serum hepatitis B virus(HBV)RNA on liver significant inflammation in chronic hepatitis B(CHB)patients with normal or mildly elevated alanine transaminase(ALT)levels.Methods A total of 211 treatment-naive CHB patients with ALT<two times of the upper limit of normal in Shanghai Public Health Clinical Center,Fudan University between January 2016 and June 2019 were retrospectively studied.All of them received liver biopsy.Serum HBV RNA levels were quantified by quantitative reverse transcription polymerase chain reaction.Statistical analyses were performed with t test,Mann-Whitney U test,chi-square test and logistic regression analysis.Results In 83 hepatitis B e antigen(HBeAg)-positive patients,the serum HBV RNA levels decreased with the increasing severity of liver inflammation((6.208±1.363)lg copies/mL vs(4.654±0.962)lg copies/mL,t=6.035,P<0.01).In 138 HBeAg-negative patients,the serum HBV RNA levels increased with the increasing severity of liver inflammation((3.101±0.720)lg copies/mL vs(3.965±0.782)lg copies/mL,t=-5.892,P<0.01).Logistic regression analysis showed that serum HBV RNA level was an independent predictor for significant liver inflammation(odds ratio(OR)=0.168,P=0.003)in HBeAg-positive patients.Area under receiver operator characteristic curve(AUROC)was 0.82(95%confidence interval(CI)0.73-0.91)of HBV RNA and 0.56(95%CI 0.44-0.69)of ALT for the diagnosis of significant liver inflammation.The difference was statistically significant(z=2.975,P=0.003).Serum HBV RNA(OR=4.960,P<0.01),γ-glutamyl transpeptidase(OR=1.021,P=0.019)and blood platelet(PLT)(OR=0.987,P=0.008)were independent predictors for significant liver inflammation in HBeAg-negative patients.The AUROC of HBV RNA and ALT was 0.78(95%CI 0.69-0.87)and 0.65(95%CI 0.55-0.75),respectively.The AUROC of combination diagnostic model consisting of HBV RNA,γ-glutamyl transpeptidase and blood platelet was 0.86(95%CI 0.79-0.93)for the diagnosis of significant liver inflammation.Conclusi

关 键 词：乙型肝炎 慢性 肝脏炎症 乙型肝炎病毒核糖核酸 无创检测 

分 类 号：R512.62[医药卫生—内科学]