血清IL-21水平与长期核苷类药物治疗CHB患者停药后临床复发的相关性  

Correlation between serum IL-21 level and clinical relapse after long-term nucleoside treatment in patients with chronic hepatitis B

作　　者：余希[1] 莫金英 肖蒲军 詹雨林[1] 瞿志军[1] YU Xi;MO Jin-ying;XIAO Pu-jun;ZHAN Yu-lin;QU Zhi-jun(Department of Infectious Disease.Shenzhen Longgang Central Hospital,Shenzhen,Guangdong 518116,China)

机构地区：[1]深圳市龙岗中心医院感染科,广东深圳518116

出　　处：《热带医学杂志》2021年第9期1167-1171,共5页Journal of Tropical Medicine

基　　金：广东省医学科学技术研究基金(A2013624)。

摘　　要：目的探讨血清白细胞介素-21(IL-21)水平与长期核苷(酸)类药物(NA)治疗慢性乙型肝炎(CHB)患者停药后临床复发的相关性。方法选择深圳市龙岗中心医院感染科2016年12月-2018年12月收治的CHB患者80例作为研究对象,对治疗前HBeAg阳性患者,根据其病情进行NA药物口服治疗至HBV-DNA下降至检测线以下,同时丙氨酸氨基转移酶(ALT)恢复正常、HBeAg发生血清学转换后巩固治疗至少12个月;对治疗前HBeAg阴性的患者,进行抗病毒治疗至HBV-DNA下降至检测线以下、ALT恢复正常、HBeAg发生血清学转换后巩固治疗18个月。根据其NA停药后是否发生临床复发分为临床复发组(n=26)和非临床复发组(n=54),比较两组患者停药后12、24、36、48周乙肝表面抗原(HBsAg)、HBV-DNA、ALT、IL-21水平变化;以Pearson法分析IL-21水平与HBsAg、HBV-DNA、ALT及HBeAg的相关性,并采用受试者工作特征曲线(ROC)对血清IL-21对于NA治疗CHB患者停药后复发的诊断价值进行评价。结果随着停药时间的延长,患者HBsAg、HBV-DNA、ALT、IL-21水平不断升高,停药12、24、36及48周时临床复发组HBsAg、HBV-DNA、ALT、IL-21水平高于非临床复发组,差异均有统计学意义(P<0.05)。停药期间,CHB患者血清IL-21与HBV-DNA、ALT、HBsAg水平呈正相关关系(r=0.315、0.203、0.206,P均<0.05)。ROC分析结果显示,血清IL-21水平用于NA治疗CHB患者停药后复发的诊断,其曲线下面积(AUC)为0.849,95%CI为0.762~0.936,差异有统计学意义(P<0.001)。结论NA治疗CHB患者停药后血清IL-21与HBVDNA、ALT水平呈现相似的波动趋势,其水平高低对于患者临床复发具有一定的诊断价值。Objective To investigate the correlation between serum interleukin-21(IL-21)level and clinical relapse after long-term nucleoside acid(NA)drugs treatment for patients with chronic hepatitis B(CHB).Methods 80 patients with CHB admitted to the Department of Infectious Diseases,Shenzhen Longgang Central Hospital,between December 2016 and December 2018 were selected as the research object.Patients who were HBeAg positive before treatment were treated with NA drugs according to their condition until the HBV-DNA dropped to the test.Consolidate therapy for at least 12 months after alanine aminotransferase(ALT)returns to normal and HBeAg seroconversion occurs;antiviral treatment is given to patients who are HBeAg negative before treatment until HBV-DNA drops below the detection line,ALT returns to normal,and HBeAg serology occurs Consolidation treatment was 18 months after the conversion.They were divided into clinical relapse group(CR,n=26)and non-clinical relapse group(NCR,n=54).The changes of HBsAg,HBV-DNA,ALT,and IL-21 levels at 12,24,36 and 48 weeks after withdrawal of the two groups of patients were compared.Pearson method was used to analyze the correlation between IL-21 level and HBsAg,HBV-DNA,ALT and HBeAg,and the receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of serum IL-21 for relapse after NA treatment in patients with CHB.Results With the extension of drug withdrawal time,the HBsAg,HBV-DNA,ALT and IL-21 levels of patients continued to increase.The levels of HBsAg,HBV-DNA,ALT and IL-21 in CR group were higher than those in NCR group at 12,24,36 and 48 weeks after drug withdrawal.The difference was statistically significant(P<0.05).During drug withdrawal,serum IL-21 level in CHB patients had a positive correlation with HBV-DNA,ALT,HBsAg levels(r=0.315,0.203,0.206,P<0.05);ROC analysis for serum IL-21 level used for the diagnosis of relapse after NA treatment in patients with CHB showed the area under the curve(AUC)was 0.849,and the 95%CI value was 0.762~0.936,which was sta

关 键 词：白细胞介素-21 核苷(酸)类药物 慢性乙型肝炎 临床复发 

分 类 号：R512.62[医药卫生—内科学]