经NAs长期治疗后HBV,DNA低于检测下限乙型肝炎肝硬化患者的HBV,RNA水平分析及其意义  

Analysis and significance of HBV DNA below the lower detection limit of HBV RNA levels after long-term NAs antiviral therapy in patients with hepatitis B virus cirrhosis

作　　者：王春妍[1] 曹宇[2] 冯永美 李静 蒋贝[2] 张彦 文君[1] 朱玉瑾 李嘉[1] Wang Chunyan;Cao Yu;Feng Yongmei;Li Jing;Jiang Bei;Zhang Yan;Wen Jun;Zhu Yujin;Li Jia(Department of Chronic Liver Disease,Tianjin Second People's Hospital,Tianjin 300192,China;Hepatopathy Research Institute,Tianjin Second People's Hospital,Tianjin 300192,China;Graduate School of Tianjin Medical University,Tianjin 300192,China)

机构地区：[1]天津市第二人民医院肝病科,天津300192 [2]天津市第二人民医院肝病医学研究所,天津300192 [3]天津医科大学研究生院,天津300192

出　　处：《中华肝脏病杂志》2022年第7期758-762,共5页Chinese Journal of Hepatology

基　　金：天津市青年科学基金 (18JCQNJCH800)。

摘　　要：目的长期核苷(酸)类似物(NAs)治疗后HBV DNA低于检测下限的乙型肝炎肝硬化患者HBV RNA水平分析及其意义。方法选取2018年5月至2019年7月收治的乙型肝炎肝硬化患者97例,至少3年NAs抗病毒治疗,至少2次间隔6个月高敏检测HBV DNA小于20 IU/ml,进行丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰转移酶(GGT)、HBsAg、HBeAg及HBV RNA检测。根据Child-Pugh分级、HBeAg水平、HBsAg水平分组,比较各组间HBV RNA水平。对资料进行秩和检验、χ^(2)检验和线性回归分析。结果与Child-Pugh A级患者HBV RNA水平比较,B+C级患者HBV RNA水平明显升高[4.1(0,4.9)log10拷贝/ml与2.0(0,3.5)log10拷贝/ml],差异有统计学意义(Z=2.370,P<0.05)。依据HBeAg水平不同,分为HBeAg阳性组及HBeAg阴性组,2组间HBV RNA水平定量比较[2.0(0,4.5)log10拷贝/ml与1.0(1.0,2.0)log10拷贝/ml],差异具有统计学意义(Z=3.233,P<0.05)。依据HBsAg水平不同,分为HBsAg≤100 IU/ml、100<HBsAg<1000 IU/ml及HBsAg≥1000 IU/ml 3组,3组间HBV RNA水平定量比较[0(0,2.0)log10、2.0(0,4.6)log10与2.2(2.0,4.7)log10拷贝/ml],差异具有统计学意义(H=11.265,P<0.05)。纳入性别、年龄、ALT、AST、GGT、HBsAg、HBeAg进行线性回归分析,HBsAg、AST水平与HBV RNA定量相关(P<0.05)。随访1年,记录不良事件发生情况。60例HBV RNA可测患者中,19例(31.7%)出现不良事件;37例HBV RNA检测不到患者中,3例(8.1%)出现不良事件,两者之间差异有统计学意义(χ^(2)=7.24,P<0.05)。结论长期NAs抗病毒治疗的乙型肝炎肝硬化患者,在HBV DNA低于检测下限后,HBV RNA仍可检测到;Child-Pugh分级B、C级患者,HBV RNA定量水平更高;HBV RNA可测患者出现不良事件比例较高;AST、HBsAg水平可能与血清HBV RNA水平相关。Objective To analyze the significance of HBV DNA below the lower detection limit of HBV RNA levels after long-term nucleos(t)ide analogues(NAs)antiviral therapy in patients with hepatitis B virus cirrhosis.Methods 97 cases with hepatitis B virus cirrhosis treated with NAs antiviral therapy for at least 3 years between May 2018 to July 2019 were selected.High-sensitivity HBV DNA(<20 IU/ml),alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyltransferase(GGT),HBsAg,HBeAg and HBV RNA at least twice every 6 months were detected.According to Child-Pugh classification,HBeAg,HBsAg level,and HBV RNA level intergroup comparison was performed.Rank sum test,χ^(2) test and linear regression analysis were performed on the data.Results Compared with the HBV RNA level of child-Pugh class A patients,the HBV RNA level of Child-Pugh class B+C patients were significantly higher[4.1(0,4.9)log10 copies/ml and 2.0(0,3.5)log10 copies/ml],and the difference was statistically significant(Z=2.370,P<0.05).According to different HBeAg levels,they were divided into HBeAg positive and negative group,and the quantitative comparison of HBV RNA levels between the two groups were 2.0(0,4.5)log10 copies/ml and 1.0(1.0,2.0)log10 copies/ml,respectively,and the difference was statistically significant(Z=3.233,P<0.05).According to different HBsAg levels,they were divided into three groups:HBsAg≤100 IU/ml,100<HBsAg<1000 IU/ml,and HBsAg≥1000 IU/ml,and the quantitative comparison of HBV RNA levels among the three groups were 0(0,2.0)log10,2.0(0,4.6)log10,and 2.2(2.0,4.7)log10 copies/ml,respectively,and the difference was statistically significant(H=11.265,P<0.05).Gender,age,ALT,AST,GGT,HBsAg,and HBeAg were included for linear regression analysis,and the HBsAg and AST levels were correlated with HBV RNA quantification(P<0.05).Adverse events occurrence during 1-year follow-up were recorded.19(31.7%)out of 60 cases had adverse events with detectable HBV RNA,and 3(8.1%)out of 37 cases had adverse events with undetectable HBV RNA,and

关 键 词：肝硬化 肝炎病毒 乙型 核苷(酸)类似物 DNA RNA 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]