慢性乙型肝炎和乙型肝炎肝硬化患者发生低病毒血症的影响因素及其与肝脏炎症、肝纤维化进展的关系o-展  

Influencing factors for low-level viremia in patients with chronic hepatitis B or hepatitis B liver cirrhosis and its association with the progression of liver inflammation and liver fibrosis

作　　者：宣碧碧 徐永红[2] 杜忠彩 刘玉 杨玉玲[3] 边城[3] XUAN Bibi;XU Yonghong;DU Zhongcai;LIU Yu;YANG Yuling;BIAN Cheng(Qingdao University Medical College,Qingdao,Shandong 266021,China;Department of Gastroenterology,The Affiliated Hospital of Qingdao University,Qingdao,Shandong 266003,China;Department of Infectious Diseases,The Affiliated Hospital of Qingdao University,Qingdao,Shandong 266003,China;Department of Critical Care Medicine,The Affiliated Hospital of Qingdao University,Qingdao,Shandong 266003,China)

机构地区：[1]青岛大学医学部,山东青岛266021 [2]青岛大学附属医院消化内科,山东青岛266003 [3]青岛大学附属医院感染性疾病科,山东青岛266003 [4]青岛大学附属医院重症医学科,山东青岛266003

出　　处：《临床肝胆病杂志》2022年第10期2252-2259,共8页Journal of Clinical Hepatology

基　　金：国家自然科学基金(RZ1900014929)。

摘　　要：目的 研究接受抗病毒治疗的慢性乙型肝炎(CHB)和乙型肝炎肝硬化患者发生低病毒血症(LLV)的影响因素以及LLV与肝脏炎症、纤维化进展的关系。方法 选取2020年7月1日—2021年11月30日就诊于青岛大学附属医院肝病门诊口服核苷(酸)类(NUC)药物抗病毒治疗疗程≥1年,且HBV DNA<2000 IU/mL的CHB和乙型肝炎肝硬化患者417例,根据HBV DNA水平将患者分为LLV组(10 IU/mL≤HBV DNA<2000 IU/mL)和完全病毒学应答(CVR)组(HBV DNA<10 IU/mL),比较两组患者抗病毒治疗前后一般资料、病毒学、生化学及肝纤维化指标等方面的差异,分析发生LLV的影响因素。此外,比较两组患者抗病毒治疗前、后肝脏炎症和纤维化指标变化程度,分析LLV与肝脏炎症、纤维化进展的关系。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验。计数资料两组间比较采用χ^(2)检验。相关性检验采用Kendall’s tau-b分析。采用Logistic多因素回归分析LLV发生的影响因素。结果 417例CHB和肝硬化患者中有173例发生LLV,LLV构成比为41.5%,且以10 IU/mL≤HBV DNA<1000 IU/mL为主,占比达94.8%。Logistic回归分析结果显示,抗病毒治疗前患者HBeAg阳性(OR=3.009,95%CI:1.346~6.729,P=0.007)、有肝硬化或HCC家族史(OR=2.929,95%CI:1.344~6.383,P=0.007)及HBV DNA水平>1.0×10^(8) IU/mL(OR=10.790,95%CI:1.265~92.007,P=0.030)是LLV发生的危险因素,而AST>40 U/L(OR=0.355,95%CI:0.171~0.737,P=0.005)是LLV发生的保护因素。抗病毒治疗后HBeAg阳性(OR=4.394,95%CI:1.962~9.841,P<0.001)仍是LLV发生的危险因素;2年≤抗病毒治疗疗程<3年(OR=0.175,95%CI:0.046~0.674,P=0.010)和抗病毒治疗疗程≥3年(OR=0.170,95%CI:0.048~0.600,P=0.006)是LLV发生的保护因素。CVR组患者抗病毒治疗后AST、AFP、APRI、FIB-4变化程度(ΔAST、ΔAFP、ΔAPRI、ΔFIB-4)均较LLV组明显(P值均<0.05)。相关分析结果显示,ΔAST(τ=-0.192,P<0.001)、ΔAFP(τ=-0.192,P<0.001)、ΔAPRI(τ=-0.210,P=0.002)、ΔFIB-Objective To investigate the influencing factors for low-level viremia(LLV) in patients with chronic hepatitis B(CHB) or hepatitis B liver cirrhosis(LC) receiving antiviral therapy and the association of LLV with the progression of liver inflammation and liver fibrosis.Methods A total of 417 patients with CHB or LC who attended the outpatient service of liver diseases in The Affiliated Hospital of Qingdao University from July 1,2020 to November 30,2021 were enrolled,and all patients received oral administration of nucleos(t)ide analogues as antiviral therapy for ≥1 year and had an HBV DNA level of <2000 IU/mL.According to the HBV DNA level,the patients were divided into LLV group(10 IU/mL ≤HBV DNA <2000 IU/mL) and complete virologic response(CVR) group(HBV DNA <10 IU/mL).The two groups were compared in terms of general data,virology,biochemistry,and liver fibrosis markers before and after antiviral therapy to investigate the influencing factors for LLV.Meanwhile,the degree of changes in liver inflammation and liver fibrosis markers after antiviral therapy was compared between the two groups to analyze the association of LLV with the progression of liver inflammation and liver fibrosis.The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.The Kendall’s tau-b method was used for correlation analysis,and a multivariate logistic regression analysis was used to investigate the influencing factors for LLV.Results Among the 417 patients with CHB or LC,173 developed LLV,and the constituent ratio of LLV was 41.5%;the patients with 10 IU/mL≤HBV DNA <1000 IU/mL accounted for 94.8%.The logistic regression analysis showed that positive HBeAg(odds ratio [OR]=3.009,95%CI:1.346-6.729,P=0.007),a family history of LC or HCC(OR=2.929,95%CI:1.344-6.383,P=0.007),and HBV DNA >1.0×10^(8) IU/mL(OR=10.790,95%CI:1.265-92.007,P=0.030) before antiviral therapy were risk factors for

关 键 词：乙型肝炎 慢性 肝硬化 低病毒血症 影响因素分析 

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