血清HBsAg和HBeAg定量检测评估恩替卡韦治疗乙型肝炎肝硬化合并原发性肝癌患者病毒应答的临床价值  

Clinical value of quantitative detection of serum HBsAg and HBeAg to evaluate the viral response of enteca⁃vir in patients with hepatitis B cirrhosis complicated with primary liver cancer

作　　者：张心怡 张国梁 张广林 ZHANG Xinyi;ZHANG Guo-liang;ZHANG Guanglin(Department of Hepatology,Anhui Hospital of Integrated Traditional Chinese and Western Medicine,Hefei 230000,China)

机构地区：[1]安徽省中西医结合医院肝病科,合肥230000

出　　处：《实用医学杂志》2023年第17期2241-2247,共7页The Journal of Practical Medicine

基　　金：安徽省卫生健康委员会一般科研项目(编号:B2022863)。

摘　　要：目的探讨定量检测乙肝病毒表面抗原(HBsAg)和乙肝病毒E抗原(HBeAg)血清水平评估恩替卡韦治疗乙型肝炎肝硬化合并原发性肝癌患者病毒应答(HBV-DNA)的临床价值。方法选取我院2020年4月至2021年7月收治的80例乙型肝炎中度肝硬化合并原发性肝癌Ⅱa期患者,根据治疗的第8周时是否发生病毒学应答分为应答组47例和未应答组33例。比较患者治疗前后血清HBsAg、HBeAg水平与HBV-DNA水平的相关性,受试者工作特征(ROC)曲线确定血清HBsAg、HBeAg水平对病毒应答的预测价值,Kaplan-Meier法生存分析1年生存率。结果患者治疗前血清HBsAg、HBeAg水平与HBV-DNA水平呈正相关,患者治疗第8、12、24、36、48周时血清HBsAg和HBeAg水平变化差异均有统计学意义(P<0.01)。治疗第48周时,血清HBsAg水平预测病毒应答ROC曲线下面积最大0.818(95%CI:0.709~0.965),最佳截点为(40.63±10.28)ng/mL,灵敏度为91.34%,特异度为71.93%;治疗第8周时,血清HBeAg水平预测病毒应答的ROC曲线下面积最大0.801(95%CI:0.673~0.979),最佳截点为(53.38±9.86)NCU/mL,灵敏度为88.52%,特异度为83.42%。生存分析结果显示,应答组1年生存率为87.31%高于未应答组62.18%,差异有统计学意义(P<0.05)。结论恩替卡韦治疗的乙型肝炎肝硬化合并原发性肝癌患者血清HBsAg和HBeAg水平与病毒应答存在相关性,定量检测血清HBsAg和HBeAg水平评估患者病毒应答具有较高临床价值。Objective To explore the clinical value of quantitative detection of hepatitis B surface antigen(HBsAg)and hepatitis B virus E antigen(HBeAg)serum levels to evaluate the viral response(HBV⁃DNA)of ente⁃cavir in patients with hepatitis B cirrhosis complicated with primary liver cancer.Methods From April 2020 to July 2021,80 patients with moderate liver cirrhosis complicated with primary liver cancer were treated in our hospital.According to whether virological response occurred at the 8th week of treatment,the patients were divided into response group(n=47)and non⁃response group(n=33).The correlations between serum HBsAg,HBeAg and HBV⁃DNA levels were compared before and after treatment.The value of serum HBsAg and HBeAg levels in predict⁃ing viral response was determined by receiver operating characteristic(ROC)curve.The 1⁃year survival rate was analyzed by Kaplan⁃Meier method.Results The serum levels of HBsAg and HBeAg were positively correlated with the level of HBV⁃DNA before treatment.There were significant differences in serum HBsAg and HBeAg levels at 8 weeks,12 weeks,24 weeks,36 weeks and 48 weeks after treatment.At the 48th week of treatment,the maximum area under the ROC curve of viral response predicted by serum HBsAg level was 0.818(95%CI:0.709~0.965).The best cut⁃off point was(40.63±10.28)ng/mL.The sensitivity is 91.34%.The specificity is 71.93%.At the 8th week of treatment,the area under the ROC curve predicted by serum HBeAg level was up to 0.801(95%CI:0.673~0.979).The best cut⁃off point was(53.38±9.86)NCU/mL.The sensitivity is 88.52%and the specificity is 83.42%.The results of survival analysis showed that the 1⁃year survival rate of the response group was 87.31%higher than that of the non⁃response group 62.18%,and the difference was statistically significant(P<0.05).Conclusion Serum HBsAg and HBeAg levels were correlated with viral response in patients with hepatitis B cirrhosis complicated with primary liver cancer treated with entecavir.Quantitative detection of serum HBs

关 键 词：乙型肝炎肝硬化 原发性肝癌 乙肝病毒表面抗原 乙肝病毒E抗原 病毒应答 

分 类 号：R735.7[医药卫生—肿瘤]