血乙型肝炎病毒RNA定量检测在慢性乙型肝炎患者精准诊疗中的价值  

The value of quantitative detection of HBV RNA in the accurate diagnosis and treatment of chronic hepatitis B patients

作　　者：刘项君 余坚[1] 陈占国[1] LIU Xiang-jun;YU Jian;CHEN Zhan-guo(Center for Clinical Laboratories,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China;不详)

机构地区：[1]温州医科大学附属第二医院临床检验中心,浙江温州325000 [2]温州医科大学检验医学院生命科学学院,浙江温州325035

出　　处：《中国卫生检验杂志》2021年第14期1678-1683,共6页Chinese Journal of Health Laboratory Technology

基　　金：浙江省自然科学基金项目(LGF20H200005);温州医科大学附属第二医院博士启动基金(FEY001)。

摘　　要：目的评价血乙型肝炎病毒(HBV)RNA定量在慢性乙型肝炎(CHB)患者核苷类似物(NAs)治疗疗效监测中的价值,分析HBV RNA与其他HBV相关指标的相关性。方法选取169例CHB患者,其中149例NAs抗病毒治疗的患者设为治疗组,20例无抗病毒治疗的患者设为未治疗组,检测所有患者的HBV RNA,并收集同期检测的HBV DNA、HBsAg、HBeAg和ALT等数据。分析治疗组的HBV RNA定量结果与其他指标进行相关性分析,并将HBV RNA与HBV DNA阳性检出率进行比较。结果在CHB未治疗组中,HBV RNA与HBeAg、HBV DNA高度相关(r=0.856;r=0.938,P<0.01)。在CHB治疗组中,HBV RNA与HBeAg、HBV DNA显著正相关(r=0.552;r=0.511,P<0.01)。治疗组总体上HBV DNA与HBV RNA的阳性率分别是33.56%(50/149)和54.36%(81/149),差异有统计学意义(P<0.01);治疗组HBeAg阳性亚组的HBV RNA阳性率高于HBeAg阴性亚组,差异有统计学意义(P<0.01)。结论与HBV DNA和HBeAg一样,血HBV RNA可辅助诊断未治疗HBV携带患者,但在NAs抗病毒治疗的CHB患者中,血HBV RNA水平较HBV DNA能更灵敏地反映体内HBV的活动,能更好地反映治疗效果。Objective To evaluate the value of quantitative HBV RNA in monitoring the therapeutic effect of nucleoside analogues(NAs)in patients with chronic hepatitis B(CHB),and to analyze the correlation between HBV RNA and other HBV related indexes.Methods A total of 169 CHB patients were selected,including 149 patients receiving antiviral treatment for NAS as the treatment group and 20 patients without antiviral treatment as the untreated group.HBV RNA of all patients was detected,and HBV DNA,HBsAg,HBeAg and ALT data were collected simultaneously.The quantitative results of HBV RNA in the treatment group were analyzed for correlation analysis with other indicators,and the positive rates of HBV RNA and HBV DNA were compared and analyzed.In the untreated group,only the correlation between HBV RNA quantification and other indicators was analyzed.Results In untreated group,HBV RNA was highly correlated with HBeAg and HBV DNA(r=0.856,r=0.938,P<0.01).In the treatment group,HBV RNA was significantly correlated with HBeAg and HBV DNA(r=0.552,r=0.511,P<0.01).In the treatment group,the positive rates of HBV DNA and HBV RNA were 33.56%(50/149 cases)and 54.36%(81/149 cases)respectively,and the difference was statistically significant(P<0.01).However,in the HBeAg negative patients,the difference between HBV DNA and HBV RNA was not statistically significant(P>0.05);the positive rate of HBV RNA in HBeAg positive subgroup was higher than that in HBeAg negative subgroup(P<0.01).Conclusion Same as HBV DNA and HBeAg,blood HBV RNA can assist in the diagnosis of untreated HBV carriers,but in CHB patients treated with anti-virus therapy of NAs,the level of blood HBV RNA can more sensitively reflect the activity of HBV in vivo and better reflect the therapeutic effect than HBV DNA.

关 键 词：慢性乙型肝炎 乙型肝炎病毒核糖核酸 乙型肝炎病毒脱氧核糖核酸 抗病毒治疗 疗效监测 

分 类 号：R512.62[医药卫生—内科学]