抗病毒治疗慢性乙型肝炎患者发生低病毒血症的危险因素  

Risk factors for hypoviremia in chronic hepatitis B patients undergoing antiviral therapy:A comprehensive analysis

作　　者：何谱 刘文宗 HE Pu;LIU Wen-zong(Department of General Surgery,Shijiazhuang Fifth Hospital,Hebei 050000,China)

机构地区：[1]石家庄市第五医院普外科,河北石家庄050000

出　　处：《肝脏》2024年第9期1105-1108,共4页Chinese Hepatology

基　　金：2019年度河北省医学科学研究重点课题(20191456)。

摘　　要：目的 探讨抗病毒治疗慢性乙型肝炎患者发生低病毒血症的危险因素。方法 选取石家庄市第五医院抗病毒治疗的慢性乙型肝炎患者108例,分为低病毒血症组60例,完全病毒学应答组48例。比较两组患者的临床资料,logistic回归模型分析患者发生低病毒血症的危险因素。结果 低病毒血症的二线初治率显著高于完全病毒学应答组,为18.75%(6/32)比2.63%(2/76),用药依从性显著低于完全病毒学应答组为71.88%(23/32)比91.67%(55/76),差异有统计学意义(P<0.05)。两组的AST为(30.22±8.34)U/L比(28.30±8.23)U/L、ALT为(25.35±3.49)U/L比(27.03±4.63)U/L、TBil为(14.35±3.71)μmol/L比(13.74±2.87)μmol/L及HBcAb为(94.66±23.82)S/CO比(95.14±26.73)S/CO,差异均无统计学意义(P>0.05)。低病毒血症组的HBeAg阳性率为59.38%比10.53%、HBsAg为(3.24±0.36)IgIU/ml比(2.87±0.32)IgIU/ml、基线HBV DNA为(7.40±1.33)比(5.78±1.42),均显著高于完全病毒学应答组(P<0.05)。用药情况(二线初治)、HBeAg阳性、HBsAg水平、基线HBV DNA水平与完全病毒学应答呈负相关(r=-0.411、-0.352、-0.413、-0.492,P<0.05),用药依从性好与完全病毒学应答呈正相关(r=0.425,P<0.05)。Logistic回归分析结果显示,HBeAg阳性、HBsAg水平、基线HBV DNA水平是低病毒血症的危险因素(OR=2.809、1.861、1.311,P<0.05),用药依从性好是低病毒血症的保护因素(OR=0.810,P<0.05)。结论 慢性乙型肝炎患者抗病毒治疗前HBeAg阳性、HBV DNA高载量、HBsAg高定量是发生低病毒血症的危险因素,用药依从性好则有助于获得病毒学应答,临床应尽早对具备高危因素的CHB患者采取针对性干预措施。Objective To identify risk factors associated with hypoviremia in chronic hepatitis B patients receiving antiviral therapy.Methods A total of 108 chronic hepatitis B patients receiving antiviral treatment at our hospital were selected for this study.Based on high-sensitivity HBV DNA quantitative testing results,they were catergorized into a hypoviremia group(60 cases)and a complete virological response group(48 cases).Clinical data from both groups were collected and compared,and logistic regression analysis was employed to identify risk factors associated with hypoviremia.Results The rate of second-line initial treatment in the hypoviremia group was significantly higher than that in the complete virological response group(18.75%vs 2.63%,P<0.05),while the medication adherence rate was significantly lower(71.88%vs 91.67%,P<0.05).No statistically significant differences were observed bettwen the two groups in AST[(30.22±8.34)U/L vs(28.30±8.23)U/L],ALT[(25.35±3.49)U/L vs(27.03±4.63)U/L],TBil[(14.35±3.71)μmol/L vs(13.74±2.87)μmol/L],or HBcAb levels[(94.66±23.82)S/CO vs(95.14±26.73)S/CO](P>0.05).However,the hypoviremia group exhibted significantly higher rates of HBeAg positivity(59.38%vs 10.53%),HBsAg levels[(3.24±0.36)IgIU/ml vs(2.87±0.32)IgIU/ml],and baseline HBV DNA levels[(7.40±1.33)vs(5.78±1.42)]compared to the complete virological response group(P<0.05).The factors of second-line initial treatment,HBeAg positivity,HBsAg levels,and baseline HBV DNA levels were negatively correlated with complete virological response(r=-0.411,-0.352,-0.413,-0.492,P<0.05),while good medication adherence is positively correlated(r=0.425,P<0.05).Logistic regression analysis identified HBeAg positivity,HBsAg levels,and baseline HBV DNA levels as significant risk factors for hypoviremia(OR=2.809,1.861,1.311,P<0.05),whereas good medication adherence emerged as a protective factor(OR=0.810,P<0.05).Conclusion Positive HBeAg,elevated HBV DNA load,and high HBsAg levels prior to antiviral treatment are significant risk factors

关 键 词：低病毒血症 抗病毒治疗 慢性乙型肝炎 危险因素 病毒学应答 

分 类 号：R512.62[医药卫生—内科学]