慢性乙型肝炎患者发生血清HBeAg阴转影响因素分析  

Analysis of influencing factors of serum HBeAg loss in patients with chronic hepatitis B

作　　者：顾子杨 宋咪 武悦 王安辉 黄长形 GU Zi-yang;SONG Mi;WU Yue;WANG An-hui;HUANG Chang-xing(Department of Infectious Diseases,Second Affiliated Hospital of Air Force Medical University,Xi'an,Shaanxi 710038,China;Department of Epidemiology,School of Public Health of Air Force Medical University,Xi'an,Shaanxi 710032,China)

机构地区：[1]空军军医大学第二附属医院传染病科,陕西西安710038 [2]空军军医大学军事预防医学系流行病学教研室,陕西西安710032

出　　处：《中国热带医学》2023年第5期456-461,共6页China Tropical Medicine

基　　金：国家自然科学基金项目(No.81872670)。

摘　　要：目的 探索慢性乙型肝炎(chronic hepatitis B,CHB)患者发生血清HBeAg阴转的影响因素,为CHB有效治疗提供依据。方法 在空军军医大学第二附属医院传染科门诊收集HBeAg阳性CHB患者,建立观察随访队列,定期随访和检测实验室检查指标,分析HBeAg阳性CHB患者随访期间血清HBeAg变化情况,根据患者血清HBeAg是否发生阴转将研究对象分为病例组(血清HBeAg阴转)和对照组(血清HBeAg未阴转),分析比较两组患者基线资料特点,并采用Cox单因素及多因素回归分析血清HBeAg阴转的影响因素。结果 共纳入HBeAg阳性CHB患者634例,共累计随访2 570.01人年,其中发生血清HBeAg阴转237例,平均随访时间为40.92月,血清HBeAg阴转率为9.22/100人年。血清HBeAg阴转组与血清HBeAg未阴转组在HBV家族史、抗病毒治疗、基线WBC、PLT、ALT、AST、T-Bil、GGT、AFP、HBsAg定量、HBeAg定量等指标差异有统计学意义(P<0.05)。Cox回归结果提示HBV家族史(HR=0.68,95%CI:0.50~0.92,P=0.012)、ALT(HR=2.06,95%CI:1.52~2.79,P<0.001)、HBsAg定量(HR=0.68,95%CI:0.48~0.95,P=0.024)、HBeAg定量(HR=0.48,95%CI:0.31~0.74,P=0.001)是HBeAg阳性CHB患者HBeAg阴转的独立影响因素。结论 无HBV家族史、初始ALT≥80 U/L、HBsAg定量<1 000 IU/mL、HBeAg定量<1 000 C.O.I的HBeAg阳性CHB患者更容易发生血清HBeAg阴转。Objective To explore the influencing factors of serum HBeAg loss in patients with chronic hepatitis B(CHB)and and provide evidence for effective treatment of CHB.Methods A follow-up cohort of HBeAg-positive CHB patients was established in the the Infectious Diseases Outpatient Clinic of hospital.Regular follow-up and laboratory test indicators were collected to analyze the changes of serum HBeAg in HBeAg-positive CHB patients during the follow-up period.The subjects were divided into the case group(serum HBeAg loss)and the control group(serum HBeAg not loss)according to whether serum HBeAg loss occurred.The baseline data characteristics of the two groups were analyzed and compared,and the influencing factors of serum HBeAg loss were analyzed by Cox univariate and multivariate regression.Results A total of 634 HBeAgpositive CHB patients were enrolled,with a total follow-up of 2570.01 person-years.Among them,237 cases of serum HBeAg loss occurred,with the mean follow-up time of 40.92 months,and the rate of HBeAg loss was 9.22/100 person-years.There were significant differences in HBV family history,antiviral therapy,baseline WBC,PLT,ALT,AST,T˗Bil,GGT,AFP,quantitative HBsAg and quantitative HBeAg between serum HBeAg loss group and serum HBeAg not loss group(P<0.05).Cox regression analysis showed that family history of HBV(HR 0.68,95%CI:0.50-0.92,P=0.012),ALT(HR2.06,95%CI:1.52-2.79,P<0.001),quantitative HBsAg(HR 0.68,95%CI:0.48-0.95,P=0.024),quantitative HBeAg(HR 0.48,95%CI:0.31-0.74,P=0.001)were independent influencing factors for HBeAg loss in HBeAg-positive CHB patients.Conclusions HBeAgpositive CHB patients without family history of HBV,initial ALT≥80 U/L,quantitative HBsAg<1000 IU/ml,quantitative HBeAg<1000 C.O.I are more likely to have serum HBeAg loss.

关 键 词：乙型肝炎 慢性 乙型肝炎E抗原 阴转 影响因素 

分 类 号：R512[医药卫生—内科学]