HBsAg、cccDNA和pgRNA水平检测在慢性乙型肝炎诊治中的价值  

The value of HBsAg,cccDNA and pgRNA level detection in the diagnosis and treatment of chronic hepatitis B

作　　者：李解军 冯煦[1] 常瑞霞[1] Li Xiejun;Feng Xu;Chang Ruixia(Zhengzhou Sixth People′s Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市第六人民医院,郑州450000

出　　处：《保健医学研究与实践》2021年第4期95-98,102,共5页Health Medicine Research and Practice

摘　　要：目的探讨乙型肝炎表面抗原(HBsAg)、共价闭合环状DNA(cccDNA)、合成前基因组RNA(pgRNA)水平检测在慢性乙型肝炎(CHB)诊治中的价值。方法选取2019年1月-2021年4月在郑州市某医院接受治疗的83例CHB患者为研究对象。采用定量聚合酶链式反应检测pgRNA水平;采用化学发光法检测血清HBsAg水平;提取肝活检组织中的DNA进行cccDNA检测。比较治疗前不同分期患者pgRNA、HBsAg以及cccDNA水平。分析治疗前患者血清pgRNA与HBsAg、cccDNA的关系。比较患者在治疗前、治疗6个月、12个月时的pgRNA、HBsAg以及cccDNA水平。比较pgRNA、HBsAg以及cccDNA水平在判断CHB患者病情进展情况中的价值,包括敏感度、特异度以及准确度。结果不同分期CHB患者的pgRNA水平比较,差异均有统计学意义(P<0.05)。Ⅰ期CHB患者pgRNA水平均高于Ⅱ、Ⅲ、Ⅳ期患者,Ⅱ期CHB患者pgRNA水平高于Ⅲ、Ⅳ期患者,差异均有统计学意义(P<0.05)。对于所有CHB患者,pgRNA水平与HBsAg、cccDNA水平呈正相关关系(P<0.05);对于Ⅰ、Ⅱ期CHB患者,pgRNA水平与HBsAg、cccDNA水平呈正相关关系(P<0.05)。治疗6、12个月时,患者pgRNA水平均低于治疗前,差异均有统计学意义(P<0.05)。治疗6、12个月时,患者HBsAg水平均低于治疗前;同时治疗12个月时,患者HBsAg水平低于治疗6个月时,差异均有统计学意义(P<0.05)。治疗6、12个月时,患者cccDNA水平均低于治疗前;同时治疗12个月时,患者cccDNA水平低于治疗6个月时,差异均有统计学意义(P<0.05)。cccDNA与pgRNA的AUC均较高,可作为判断CHB患者病情进展情况的指标,且pgRNA的预测敏感度、特异度以及准确度均较高。结论对CHB患者进行HBsAg、pgRNA以及cccDNA等指标的检测,可帮助医师准确判断患者病情进展情况,为疗效的评估、临床方案的选择提供可靠依据。Objective To explore the value of hepatitis Bsurface antigen(HBsAg),covalent closed-circular DNA(cccDNA),and pregenomic RNA(pgRNA) level detection in the diagnosis and management of chronic hepatitis B(CHB).Methods Eighty-three patients with CHB treated in a hospital in Zhengzhou from January 2019 to April 2021 were selected for the study.Quantitative polymerase chain reaction was used to detect pgRNA levels;serum HBsAg was detected by chemiluminescence;and cccDNA was detected after DNA extraction from liver biopsy tissues.pgRNA,HBsAg,and cccDNA levels were compared among patients with different stages before treatment.The relationship between serum pgRNA and HBsAg and cccDNA in patients before treatment was compared.The pgRNA,HBsAg,and cccDNA levels in patients before treatment,at 6 months,and at 12 months of treatment were compared.The value of pgRNA,HBsAg,and cccDNA levels in determining disease progression in patients with CHB was compared regarding sensitivity,specificity,and accuracy.Results The differences in pgRNA levels were statistically significant(P<0.05) when comparing patients with different stages of CHB.All stage Ⅰ CHB patients had higher pgRNA levels than stage Ⅱ,Ⅲ,and Ⅳ patients,and stage ⅡCHB patients had higher pgRNA levels than stage Ⅲ and Ⅳ patients,and the differences were statistically significant(P <0.05).For all CHB patients,pgRNA levels were positively correlated with HBsAg and cccDNA levels(P<0.05);for stage Ⅰ and Ⅱ CHB patients,pgRNA levels were positively correlated with HBsAg and cccDNA levels(P<0.05).At 6 and 12 months of treatment,the pgRNA levels of patients were lower than those before treatment,and the differences were statistically significant(P<0.05).At 6 and 12 months of treatment,patients’ HBsAg levels were lower than those before treatment;also,at 12 months of treatment,patients’ HBsAg levels were lower than those at 6 months of treatment,and the differences were statistically significant(P<0.05).At 6 and 12 months of treatment,patients’ cccDNA leve

关 键 词：乙型肝炎病毒 血清学标志物 表面抗原 合成前基因组RNA 共价闭合环状DNA 

分 类 号：R373.2[医药卫生—病原生物学]