经治慢性乙型肝炎患者低病毒血症的临床特征及危险因素分析  

Analysis of clinical characteristics and risk factors of low level viremia in patients with chronic hepatitis B after treatment

作　　者：杨雪芳 胥莹[1] 张帮婷 张雪[1] YANG Xuefang;XU Ying;ZHANG Bangting;ZHANG Xue(Department of Gastroenterology,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)

机构地区：[1]昆明医科大学第二附属医院消化内科,云南昆明650101

出　　处：《胃肠病学和肝病学杂志》2023年第3期276-281,共6页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的 分析经治慢性乙型肝炎(chronic hepatitis B, CHB)患者低病毒血症(low level viremia, LLV)的临床特征及危险因素。方法 纳入2020年10月至2021年10月就诊于昆明医科大学第二附属医院,普通血清HBV DNA检测阴性(HBV DNA<500 IU/ml),且行高敏HBV DNA检测(检测下限为HBV DNA<10 IU/ml)的抗病毒治疗≥48周的CHB患者,分为LLV组(10~499 IU/ml)及完全病毒学应答(complete virological response, CVR)组(<10 IU/ml+检测不出),分析LLV组的临床特征,找出相关血清学指标对高敏HBV DNA阳性的最佳预测值;收集患者治疗前基线资料,分析发生LLV的独立危险因素,并绘制ROC曲线评估独立危险因素及预测模型对LLV的预测价值。结果 一线药物抗病毒治疗≥48周及以上的患者中,LLV患者占比为43.1%。LLV组患者的HBeAg阳性比例、ALT、GGT均高于CVR组,A/G、PAB较CVR组低(P<0.05)。应用ROC曲线分析,ALT预测高敏检测阳性的最佳截断值为24.5 U/L。在非肝硬化患者中,LLV患者处于进展期肝纤维化的比例较CVR患者高(P<0.05)。基线HBeAg阳性、高基线HBV DNA水平、使用二线药物抗病毒治疗是LLV的独立危险因素,上述三者联合基线存在肝硬化构建的预测模型曲线下面积为0.805。结论 ALT预测高敏HBV DNA阳性(检测下限为HBV DNA<10 IU/ml)的最佳截断值为24.5 U/L,可在无法开展高敏检测的地区予以使用;使用二线药物、高基线HBV DNA水平、基线HBeAg阳性是LLV的独立危险因素,上述三者联合基线存在肝硬化构建的预测模型可较好地预测LLV的发生,但肝硬化患者的抗病毒疗效观察需结合其他相关指标。Objective To analyze the clinical characteristics and risk factors of low level viremia(LLV)in patients with chronic hepatitis B(CHB)after treatment.Methods Patients admitted to the Second Affiliated Hospital of Kunming Medical University from Oct.2020 to Oct.2021,and the normal serum HBV DNA test was negative(HBV DNA<500 IU/ml).CHB patients who underwent highly sensitive HBV DNA test(lower limit of detection was HBV DNA<10 IU/ml)for≥48 weeks of antiviral treatment were divided into the LLV group(10-499 IU/ml)and the complete virological response(CVR)group(<10 IU/ml+undetectable).The clinical characteristics of the LLV group were analyzed to find out the best predictive value of relevant serological indicators for high sensitivity positive HBV DNA.Baseline data of patients before treatment were collected to analyze independent risk factors for LLV,and ROC curves were drawn to evaluate the predictive value of independent risk factors and prediction models for LLV.Results Among patients receiving first-line antiviral therapy for≥48 weeks or more,the proportion of patients with LLV was 43.1%.The positive proportion of HBeAg,ALT and GGT in the LLV group were higher than those in the CVR group,and the A/G,PAB in the LLV group were lower than those in the CVR group(P<0.05).ROC curve analysis showed that the optimal cut-off value of ALT for predicting positive HBV DNA was 24.5 U/L.In noncirrhotic patients,a higher proportion of patients with LLV had advanced liver fibrosis than of CVR patients(P<0.05).HBeAg positive,high baseline HBV DNA level,and use of the second-line antiviral therapy were independent risk factors for LLV,and the AUC of the prediction model with cirrhosis at baseline was 0.805.Conclusion The optimal cut-off value of ALT for predicting positive HBV DNA(lower limit of detection is HBV DNA<10 IU/ml)is 24.5 U/L,which can be used in areas where high sensitivity testing cannot be carried out.The use of the second-line drugs,high baseline HBV DNA level,and baseline HBeAg positivity are independent risk

关 键 词：低病毒血症 高敏 血清HBV DNA 危险因素 

分 类 号：R575[医药卫生—消化系统]