血清HBeAg阳性慢性乙型肝炎患者接受核苷(酸)类似物治疗疗效和检测血清HBV RNA的意义  

Therapeutic effect of nucles(t)ide analogues and detection of serum HBV RNA in patients with chronic hepatitis B with positive serum HBeAg

作　　者：吕高燕 王春娟 LV Gao-yan;WANG Chun-juan(Department of Laboratory,Shandong Wendeng Orthopedic Hospital,Weihai 264400,China)

机构地区：[1]山东省文登整骨医院检验科,威海264400

出　　处：《肝脏》2024年第1期77-80,共4页Chinese Hepatology

基　　金：山东省中医药科技项目(2021M062)。

摘　　要：目的探讨血清HBeAg阳性慢性乙型肝炎患者接受核苷(酸)类似物治疗疗效和检测血清HBV RNA的意义。方法选取2018年3月—2021年1月期间山东省文登整骨医院收治的HBeAg阳性慢性乙型肝炎患者58例,采用核苷(酸)类似物治疗24周,比较治疗前后临床特征,分析血清ALT和HBV RNA对快速病毒学应答的预测价值。结果比较治疗前后临床特征可知,治疗后患者总胆红素、ALT、HBV DNA和HBV RNA水平分别为(0.2±0.1)mg/dL、(121.5±59.0)U/L、0.8(0.5,0.3)log 10拷贝/mL和1.4(1.1,1.7)log 10拷贝/mL,显著低于治疗前患者的(0.8±0.3)mg/dL、(168.3±134.6)U/L、8.4(5.1,10.6)log 10拷贝/mL和7.2(5.0,9.9)log 10拷贝/mL,血清HBV DNA阴性率和血清HBV RNA阴性率分别为94.8%和70.7%,显著高于治疗前患者的0.0%和0.0%(P<0.05);分析血清ALT和HBV RNA对快速病毒学应答的预测价值可知,ALT、HBV RNA单独预测快速病毒学应答的AUC分别为0.629、0.831,最佳截断值分别为≥142、≥1.9,灵敏度分别为59.0%、82.0%,特异度分别为72.1%、80.0%,阳性预测值分别为74.8%、86.6%,阴性预测值分别为58.2%、83.0%。结论核苷(酸)类似物对于血清HBeAg阳性慢性乙型肝炎患者具有良好的疗效,血清HBV RNA是快速病毒学应答的良好预测指标。Objective To investigate the efficacy of nucles(t)ide analogues in the treatment of chronic hepatitis B patients with positive serum HBeAg and to assess the significance of detecting serum HBV RNA.Methods A total of 58 patients with HBeAg positive chronic hepatitis B were treated with nucles(t)ide analogues for 24 weeks between March 2018 and January 2021.The study compared the clinical characteristics before and after treatment,and analyzed the predictive value of serum ALT and HBV RNA in rapid virological response.Results The comparison of clinical characteristics before and after treatment revealed that the levels of total red bilirubin,ALT,HBV DNA and HBV RNA after treatment were(0.2±0.1)mg/dL,(121.5±59.0)U/L,0.8(0.5,0.3)log 10 copies/mL and 1.4(1.1,1.7)log 10 copies/mL.These values were significantly lower than those of the before treatment group[(0.8±0.3)mg/dL,(168.3±134.6)U/L,8.4(5.1,10.6)log 10 copies/mL and 7.2(5.0,9.9)log 10 copies/mL(P<0.05)].The negative rates of serum HBV DNA and HBV RNA were 94.8%and 70.7%,significantly higher than those before treatment[0.0%and 0.0%(P<0.05)].Serum ALT and HBV RNA were found to have predictive value for rapid virological response,with the AUC values of 0.629 and 0.831 respectively.The best cutoff values for predicting rapid virological response were found to be≥142 for ALT and 1.9 for HBV RNA,with respective sensitivity of 59.0%and 82.0%,and specificities of 72.1%and 80.0%.The positive predictive values for ALT and HBV RNA were 74.8%and 86.6%,while the negative predictive values were 58.2%and 83.0%,respectively.Conclusion Nucles(t)ide analogues demonstrate strong efficacy in patients with chronic hepatitis B with positive serum HBeAg.Additionally,serum HBV RNA is identified as a reliable predictor of rapid virological response.

关 键 词：慢性乙型肝炎 乙型肝炎E抗原 核苷(酸)类似物 疗效 

分 类 号：R512.62[医药卫生—内科学]