血清HBV pgRNA在核苷类似物治疗CHB患者中的临床价值  

Clinical value of serum HBV pgRNA in nucleoside analogues treatment of CHB patients

作　　者：于彤波 付伦 赵汉东 王嘉 刘红莉 YU Tongbo;FU Lun;ZHAO Handong;WANG Jia;LIU Hongli(Department of Clinical Laboratory,Eighth Hospital of Xi′an,Xi′an,Shaanxi 710000,China;Sixth Department of Hepatology,Eighth Hospital of Xi′an,Xi′an,Shaanxi 710000,China;Department of Clinical Laboratory,Xi′an People′s Hospital/Xi′an Fourth Hospital,Xi′an,Shaanxi 710004,China)

机构地区：[1]西安市第八医院检验科,陕西西安710000 [2]西安市第八医院肝病六科,陕西西安710000 [3]西安市人民医院/西安市第四医院检验科,陕西西安710004

出　　处：《检验医学与临床》2022年第21期2881-2884,2889,共5页Laboratory Medicine and Clinic

基　　金：西安市科学技术局项目[2019114613YX001SF043(5)];国家科技重大专项项目(2017ZX10302201)。

摘　　要：目的探讨血清乙型肝炎病毒前基因组RNA(HBV pgRNA)在核苷类似物治疗慢性乙型肝炎(CHB)患者中的临床价值。方法选取2018年1月至2021年1月西安市第八医院收治的167例CHB患者为研究对象,所有CHB患者均持续接受核苷类似物治疗12个月。采用实时荧光定量聚合酶链反应检测血清HBV pgRNA。采用多因素Logistic回归分析核苷类似物治疗CHB效果的影响因素,绘制受试者工作特征曲线(ROC曲线)分析HBV pgRNA预测核苷类似物治疗效果的价值。结果167例CHB患者持续接受12个月的核苷类似物治疗后,42例(25.15%)CHB患者获得不应答,125例(74.85%)CHB患者获得应答。CHB获得不应答患者乙型肝炎病毒e抗原(HBeAg)阳性占比、HBV DNA载量、HBV pgRNA水平高于CHB获得应答患者,而CD4^(+)/CD8^(+)水平低于CHB获得应答患者,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示HBeAg状态(OR=3.849)、HBV DNA载量(OR=2.789)、HBV pgRNA(OR=4.016)为核苷类似物治疗CHB效果的影响因素(P<0.05)。ROC曲线分析显示血清HBV pgRNA预测核苷类似物治疗CHB效果的曲线下面积、灵敏度、特异度、约登指数及最佳截断点分别为0.855(95%CI:0.792~0.905)、64.29%、95.20%、0.595、5.54 lg copy/mL。结论血清HBV pgRNA表达水平与核苷类似物治疗CHB获得应答有关,检测血清HBV pgRNA水平有助于预测核苷类似物治疗CHB的效果。Objective To investigate the clinical value of serum hepatitis B virus pregenomic RNA(HBV pgRNA)in the treatment of chronic hepatitis B(CHB)patients with nucleoside analogues.Methods 167 patients with CHB treated in Eighth Hospital of Xi′an from January 2018 to January 2021 were selected as the research objects.All CHB patients continued to receive nucleoside analogues for 12 months.Serum HBV pgRNA was detected by real-time fluorescence quantitative polymerase chain reaction.Multivariate logistic regression was used to analyze the affecting factors of nucleoside analogues treatment effect in CHB,and the receiver operating characteristic curve(ROC curve)was drawn to analyze the value of HBV pgRNA in predicting the treatment effect of nucleoside analogues.Results After 12 months of nucleoside analogues therapy,42 CHB patients(25.15%)received non-response and 125 CHB patients(74.85%)received response.The proportion of hepatitis B virus E antigen(HBeAg)positive,HBV DNA load and HBV pgRNA level in CHB non-responsive patients were higher than those in CHB responsive patients,while the CD4^(+)/CD8^(+)level was lower than that in CHB responsive patients,the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that HBeAg status(OR=3.849),HBV DNA load(OR=2.789)and HBV pgRNA(OR=4.016)were the affecting factors of nucleoside analogues treatment effect on CHB(P<0.05).ROC curve analysis showed that the area under the curve,sensitivity,specificity,Youden index and the best cutoff point of serum HBV pgRNA in predicting the effect of nucleoside analogues in the treatment of CHB were 0.855(95%CI:0.792-0.905),64.29%,95.20%,0.595 and 5.54 lg copy/mL,respectively.Conclusion The expression level of serum HBV pgRNA is related to the viral response of patients with CHB treated with nucleoside analogues.Detection of serum HBV pgRNA level is helpful to predict the effect of nucleoside analogues on CHB treatment.

关 键 词：乙型肝炎病毒前基因组RNA 慢性乙型肝炎 核苷类似物 

分 类 号：R512.62[医药卫生—内科学]