HBsAg浓度对HBeAg阳性的慢性乙型肝炎患者恩替卡韦治疗效果的预测价值  

The predictive value of HBsAg concentration on the therapeutic effect of entecavir in HBeAg-positive chronic hepatitis B patients

作　　者：王洁[1] 朱姣娜 陈公英[1] 刘静[1] 龚玲[1] 施军平[1] WANG Jie;ZHU Jiaona;CHEN Gongying;LIU Jing;GONG Ling;SHI Junping(The Affiliated Hospital of Hangzhou Normal University,Hangzhou 310000,China;Ningbo Yinzhou NO.2 Hospital,Ningbo 315000,China)

机构地区：[1]杭州师范大学附属医院,浙江杭州310000 [2]宁波市鄞州区第二医院,浙江宁波315000

出　　处：《中国现代医生》2021年第16期27-31,F0003,共6页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2020KY715)。

摘　　要：目的动态监测乙型肝炎e抗原(HBeAg)阳性的慢性乙型肝炎(CHB)患者接受恩替卡韦(ETV)治疗过程中的乙型肝炎表面抗原(HBsAg)水平,探讨早期HBsAg水平对治疗效果的预测价值。方法62例HBeAg阳性的慢性乙型肝炎患者接受恩替卡韦抗病毒治疗1年,分别于0、4、8、12、24、48周检测患者乙型肝炎病毒(HBV)血清标志物、乙型肝炎病毒的脱氧核糖核酸(HBV DNA)定量、丙氨酸氨基转移酶(ALT),采用t检验、Pearson相关性分析、受试者工作特征(ROC)曲线等进行分析。结果50例CHB患者发生病毒学应答(VR+),12例CHB患者未发生病毒学应答(VR-);两组基线性别、年龄、ALT、HBV DNA载量比较,差异均无统计学意义(P>0.05);VR+组lg HBsAg浓度低于VR-组[(4.103±0.459) vs.(4.611±0.259),P=0.000]。两组HBV-DNA均随治疗时间延长而下降,治疗4周、8周、12周、24周、48周VR+组HBV DNA载量较VR-组下降明显(P<0.05)。两组lg HBsAg均随治疗时间延长而下降,两组各时间点比较,治疗4周、8周、12周、24周、48周VR+组lg HBsAg均较VR-组下降明显(P<0.05)。治疗8周时lg HBsAg浓度的ROC曲线下面积最大(AUC=0.992,P<0.05),临界值3.945 IU/mL的Youden指数最大(0.960)。结论ETV治疗8周时lg HBsAg≤3.945 IU/mL可作为预测ETV治疗1年病毒学应答的指标。Objective To dynamically monitor the hepatitis B surface antigen(HBsAg)level in patients with hepatitis B e antigen(HBeAg)positive chronic hepatitis B(CHB)receiving entecavir(ETV)treatment,and to explore the predictive value of the early HBsAg concentration for treatment effect.Methods A total of 62 HBeAg-positive patients with chronic hepatitis B received entecavir antiviral treatment for one year.The hepatitis B virus(HBV)serum markers,deoxyribonucleic acid quantification(HBV DNA),and alanine aminotransferase(ALT)were detected at 0,4,8,12,24,and 48 weeks.T-test,Pearson correlation analysis,and receiver operating characteristic(ROC)curve were used for analysis.Results 50 CHB patients had a virological response(VR+),and 12 CHB patients did not have a virological response(VR-).There was no significant difference in baseline of gender,age,ALT,and HBV DNA load between the two groups(P>0.05).The lg HBsAg concentration in the VR+group was lower than that in the VR-group[(4.103±0.459)vs.(4.611±0.259),P=0.000].Both groups of HBV-DNA decreased with the prolonged treatment time.The HBV DNA load in VR+group was significantly lower than that in VR-group after treatment for 4 weeks,8 weeks,12 weeks,24 weeks,and 48 weeks(P<0.05).The lg HBsAg of the two groups decreased with the prolonged treatment time.The lg HBsAg of VR+group was significantly lower than that of VR-group after treatment for 4 weeks,8 weeks,12 weeks,24 weeks,and 48 weeks(P<0.05).The area under the ROC curve of lg HBsAg concentration was the largest at 8 weeks of treatment(AUC=0.992,P<0.05).The Youden index of cut-off value 3.945 IU/mL was the largest(0.960).Conclusion The lg HBsAg≤3.945 IU/mL at 8 weeks of ETV treatment can be used as an index to predict the virological response of ETV treatment for one year.

关 键 词：慢性乙型肝炎 慢性乙型肝炎表面抗原 肝炎E抗原 恩替卡韦 预测价值 

分 类 号：R512.62[医药卫生—内科学]