HBeAg阳性CHB患者恩替卡韦治疗中HBcrAg水平变化及其对疗效预测价值  

Levels and predictive value of HBcrAg in CHB patients with HBeAg positive in treatment with entecavir

作　　者：陈来印 齐聪幸 安伟娜 刘静 范伟光 Chen Laiyin;Qi Congxing;An Weina;Liu Jing;Fan Weiguang(Department of Gastroenterology,Baoding People’s Hospital,Baoding 071000,Hebei Province,China;Department of Clinical Laboratory,Baoding People’s Hospital,Baoding 071000,Hebei Province,China)

机构地区：[1]保定市人民医院消化科,河北保定071000 [2]保定市人民医院检验科,河北保定071000

出　　处：《中国肝脏病杂志（电子版）》2022年第2期50-56,共7页Chinese Journal of Liver Diseases：Electronic Version

基　　金：保定市科技计划项目(2041ZF148)。

摘　　要：目的探讨乙型肝炎病毒e抗原(hepatitis B virus e antigen,HBeAg)阳性慢性乙型肝炎(chronic hepatitis B,CHB)患者恩替卡韦(entecavir,ETV)治疗中乙型肝炎病毒核心相关抗原(hepatitis B virus core-related antigen,HBcrAg)水平变化及其对治疗效果的预测价值。方法选取2019年1月至2019年9月保定市人民医院收治的133例HBeAg阳性CHB患者为研究对象。所有患者均给予ETV治疗至少48周。以治疗48周内是否完全应答分为完全应答(59例)和非完全应答(74例)。采用荧光定量PCR检测HBV DNA水平,采用全自动免疫分析仪检测HBeAg和HBsAg水平,采用化学发光酶免疫法检测HBcrAg水平,采用全自动生化分析仪检测丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、白蛋白(albumin,ALB)及肌酐(creatinine,Cr)水平。HBcrAg与HBV DNA、HBeAg、HBsAg的相关性采用Pearson相关性分析。采用受试者工作特征(receiver operator characteristic,ROC)曲线分析HBcrAg对HBeAg阳性CHB患者完全应答的预测价值。结果完全应答组患者基线HBV DNA[(5.22±1.25)lg IU/ml vs(6.57±1.50)lg IU/ml]、HBeAg[(2.53±0.56)lg S/CO vs(3.82±0.46)lg S/CO]、HBsAg[(3.34±0.77)lg IU/ml vs(3.91±0.83)lg IU/ml]、HBcrAg[(7.69±2.33)lg U/ml vs(8.36±2.67)lg U/ml]水平显著低于非完全应答组患者(P均<0.05)。Logistic多因素回归分析表明,HBV DNA(OR=27.139,95%CI:8.760~84.077,P<0.001)、HBeAg(OR=2.382,95%CI:1.505~3.768,P<0.001)、HBsAg(OR=1.197,95%CI:1.043~1.374,P=0.011)、HBcrAg(OR=1.962,95%CI:1.478~2.605,P<0.001)均为HBeAg阳性CHB患者48周内非完全应答的危险因素(P<0.05)。完全应答组患者基线、治疗12周、治疗24周、治疗48周HBcrAg水平分别为(7.20±2.33)lg U/ml、(6.12±2.10)lg U/ml、(5.73±2.01)lg U/ml、(5.51±1.52)lg U/ml,非完全应答组分别为(8.36±2.67)lg U/ml、(7.83±2.43)lg U/ml、(7.16±1.87)lg U/ml、(6.43±1.73)lg U/ml。重复测量方差分析表明,两组间差异有统计学意Objective To investigate the levels and predictive value of hepatitis B virus core-related antigen(HBcrAg)in chronic hepatitis B(CHB)patients with hepatitis B virus e antigen(HBeAg)positive in treatment with entecavir(ETV).Methods A total of 133 CHB patients with HBeAg positive in Baoding People’s Hospital from January 2019 to September 2019 were selected.All patients were treated with ETV for at least 48 weeks.The patients were divided into complete response group(59 cases)and incomplete response group(74 cases)according to the response status within 48 weeks.The level of HBV DNA was detected by fluorescence PCR,HBeAg and HBsAg were detected by automatic immune analyzer,HBcrAg was detected by chemiluminescent enzyme immunoassay,alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB)and creatinine(Cr)were detected by automatic biochemical analyzer.The correlation of HBcrAg and HBV DNA,HBeAg and HBsAg were analyzed by Pearson correlation analysis.The predictive value of HBcrAg for the complete response of CHB patients with HBeAg positive was analyzed by receiver operator characteristic(ROC)curve.Results The baseline HBV DNA[(5.22±1.25)lg IU/ml vs(6.57±1.50)lg IU/ml],HBeAg[(2.53±0.56)lg S/CO vs(3.82±0.46)lg S/CO],HBsAg[(3.34±0.77)lg IU/ml vs(3.91±0.83)lg IU/ml]and HBcrAg[(7.69±2.33)lg U/ml vs(8.36±2.67)lg U/ml]levels of patients in complete response group were significantly lower than those in incomplete response group(all P<0.05).Logistic multivariate regression analysis showed that HBV DNA(OR=27.139,95%CI:8.760~84.077,P<0.001),HBeAg(OR=2.382,95%CI:1.505~3.768,P<0.001),HBsAg(OR=1.197,95%CI:1.043~1.374,P=0.011)and HBcrAg(OR=1.962,95%CI:1.478~2.605,P<0.001)were risk factors for incomplete response with 48 weeks of CHB patients with HBeAg positive.HBcrAg level of patients in complete response group at baseline,12 weeks,24 weeks and 48 weeks of treatment were(7.20±2.33)lg U/ml,(6.12±2.10)lg U/ml,(5.73±2.01)lg U/ml and(5.51±1.52)lg U/ml,respectively,which were(8.36±2.67)lg U/ml,(7.83±

关 键 词：肝炎 乙型 慢性 乙型肝炎病毒E抗原 恩替卡韦 乙型肝炎病毒核心相关抗原 预测价值 

分 类 号：R512.62[医药卫生—内科学]