血清HBV RNA预测慢性乙型肝炎患儿HBeAg血清学转换作用研究  

Study of the predictive role of serum HBV RNA on HBeAg serological conversion in children with chronic hepatitis B

作　　者：徐娇娇 史策 洪雪琦 储芳 白青魁 王晶[1] 史艳敏 郭子鑫 张芯蕊 王福川 张敏 常晓彤[1] 张秀昌 钟彦伟 Xu Jiaojiao;Shi Ce;Hong Xueqi;Chu Fang;Bai Qingkui;Wang Jing;Shi Yanmin;Guo Zixin;Zhang Xinrui;Wang Fuchuan;Zhang Min;Chang Xiaotong;Zhang Xiuchang;Zhong Yanwei(Hebei North University,Zhangjiakou 075000,China;the Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China;The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河北北方学院,张家口075000 [2]解放军总医院第五医学中心,北京100039 [3]河南中医药大学第一附属医院,郑州450000

出　　处：《中华肝脏病杂志》2023年第11期1182-1186,共5页Chinese Journal of Hepatology

基　　金：北京市科技计划(Z171100001017182);首都临床诊疗技术研究及转化应用项目(Z201100005520048)。

摘　　要：目的探讨血清乙型肝炎病毒RNA(HBV RNA)预测慢性乙型肝炎患者HBeAg血清学转换的作用。方法175例1~17岁慢性乙型肝炎患者接受干扰素α(IFNα)治疗48周。根据治疗48周时是否发生HBeAg血清学转换将患者分为HBeAg血清学转换组和未转换组。组间比较分别采用t检验和Mann-Whitney U检验;分类变量组间频数比较采用χ^(2)检验或Fisher确切概率法;采用Pearson相关进行指标间相关性分析;单因素和多因素logistics回归分析判断HBeAg血清学转换的独立预测因素;受试者操作特征曲线比较HBV RNA、HBV DNA及HBsAg对HBeAg血清学转换的预测价值。结果48周时HBeAg血清学转换率为36.0%(63/175)。HBeAg血清学转换组HBV RNA水平从基线到抗病毒治疗第12、24、36、48周的下降幅度均明显大于未转换组,两组比较,差异有统计学意义(P<0.05)。单因素和多因素回归分析结果显示,年龄、第12周HBV RNA的下降水平是HBeAg血清学转换的独立预测因素。第12周HBV RNA下降水平的受试者操作特征曲线下面积(AUROC)为0.677(95%CI:0.549~0.806,P=0.012),明显优于同期HBV DNA下降水平AUROC(0.657,95%CI:0.527~0.788,P=0.025)和HBsAg下降水平AUROC(0.660,95%CI:0.526~0.795,P=0.023)。HBV RNA第12周时水平下降>1.385 log10拷贝/ml,对HBeAg血清转换的阳性预测值为53.2%,阴性预测值为72.2%,敏感度为77.4%,特异度为57.9%。结论抗病毒治疗第12周时HBV RNA水平下降可作为慢性乙型肝炎患者HBeAg血清学转换的早期预测指标。Objective To investigate the role of serum hepatitis B virus RNA(HBV RNA)in predicting HBeAg serological conversion in children with chronic hepatitis B.Methods 175 children aged 1~17 years with chronic hepatitis B who received interferonα(IFNα)for 48 weeks were selected.Patients were divided into HBeAg seroconversion and non-conversion based on whether HBeAg seroconversion occurred at 48 weeks of treatment.T-test and Mann-Whitney U test were used to compare between groups;chisquare test or Fisher exact probability method was used to compare the frequency between groups of classified variables;and Pearson correlation was used to analyze the correlation between indicators.Univariate and multivariate logistic regression analyses were used to identify influencing factors associated with HBeAg serological conversion.The predictive effect of HBV RNA,HBV DNA,and HBsAg on HBeAg serological conversion was compared and analyzed by the receiver operating characteristic curve(ROC).Results The seroconversion rate of HBeAg at 48 weeks was 36.0%(63/175).The reduction in HBVRNA levels from baseline to the 12th,24th,36th,and 48th weeks of antiviral therapy was significantly greater in the HBeAg serological conversion group than that in the non-conversion group,and the difference was statistically significant between the two groups(P<0.05).Univariate and multivariate regression analyses showed that age and a decline in HBV RNA levels at week 12 were independent predictors of HBeAg serological conversion.The area under the ROC curve(AUROC)of HBV RNA decline at week 12 was 0.677(95%CI∶0.549-0.806,P=0.012),which was significantly better than the same period of AUROC of HBV DNA(0.657,95%CI∶0.527-0.788,P=0.025)and HBsAg(0.660,95%CI∶0.526-0.795,P=0.023)decline.HBV RNA levels decreased(>1.385 log10 copies/ml)at week 12,with a positive predictive value of 53.2%,a negative predictive value of 72.2%,a sensitivity of 77.4%,and a specificity of 57.9%for HBeAg seroconversion.Conclusion HBV RNA level lowering during the 12th week of an

关 键 词：儿童 慢性乙型肝炎 HBEAG血清转换 HBV RNA 

分 类 号：R725.1[医药卫生—儿科]