ALT正常的慢性HBV感染患者口服核苷(酸)类似物病毒学应答的预测模型建立  

Establishment of Prediction Model of Virological Response to Oral Nucleoside(Acid)Analogs in Patients with Normal Alanine Aminotransferase and Chronic Hepatitis B Virus Infection

作　　者：张岩[1] 李玉苓 乔梁[3] ZHANG Yan;LI Yuling;QIAO Liang(the First Dept.of Infectious Diseases,Cangzhou Central Hospital,Hebei Cangzhou 061000,China;Dept.of Hepatology,Cangzhou Infectious Diseases Hospital,Hebei Cangzhou 061000,China;Dept.of Clinical Laboratory,Cangzhou Central Hospital,Hebei Cangzhou 061000,China)

机构地区：[1]沧州市中心医院感染性疾病一科,河北沧州061000 [2]沧州市传染病医院中西医结合肝病科,河北沧州061000 [3]沧州市中心医院检验科,河北沧州061000

出　　处：《中国医院用药评价与分析》2025年第1期48-52,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：河北省医学科学课题计划(No.20220388)。

摘　　要：目的:探讨口服核苷(酸)类似物的丙氨酸转移酶(ALT)正常的慢性乙型肝炎病毒(HBV)感染患者的病毒学应答的预测因素,及其列线图预测模型的建立。方法:选取2020年2月至2024年2月沧州市中心医院收治的ALT正常的慢性HBV感染患者200例,根据血清HBV脱氧核糖核酸(DNA)含量将病毒学应答模式分为完全病毒学应答组(n=124)和部分病毒学应答组(n=76),收集人口学特征参数、基本临床情况及各实验室指标,采用Logistic回归模型分析部分病毒学应答的危险因素,构建部分病毒学应答列线图风险预测模型并验证其效能。结果:相较于完全病毒学应答组,部分病毒学应答组患者乙型肝炎e抗原(HBeAg)阳性占比、服药依从性“差”占比,HBV DNA、乙型肝炎表面抗原(HBsAg)水平显著升高,白蛋白水平显著降低,差异均有统计学意义(P<0.05);但两组患者在体重指数、年龄、性别、乙型病毒性肝炎家族史、高血压史、糖尿病史、抗病毒药物类型、吸烟史和饮酒史,乙型肝炎核心抗体、血尿素氮、血肌酐、血尿酸、总胆红素、碱性磷酸酶、三酰甘油、总胆固醇、空腹血糖、白细胞计数、中性粒细胞计数、血小板计数和肝硬度值方面的差异均无统计学意义(P>0.05)。Logistic回归分析显示,HBV DNA水平高、HBsAg水平高、HBeAg阳性、白蛋白水平低和服药依从性“差”是部分病毒学应答的危险因素(P<0.05)。基于上述危险因素(服药依从性、HBeAg状态,HBV DNA、HBsAg和白蛋白水平)构建部分病毒学应答的列线图风险模型,模型C指数为0.796(95%CI=0.713~0.860),ROC曲线下面积为0.857(95%CI=0.802~0.911),特异度为85.30%,灵敏度为74.40%。结论:服药依从性“差”、HBeAg阳性、HBV DNA水平升高、HBsAg水平升高和白蛋白水平降低是ALT正常的慢性HBV感染患者部分病毒学应答的独立预测因子,基于此构建的列线图预测模型有着较高的预测效能。OBJECTIVE:To probe into the predictive factors of virological response to oral nucleoside(acid)analogs in patients with normal alanine aminotransferase(ALT)and chronic hepatitis B virus(HBV)infection,and to establish the column chart prediction model.METHODS:A total of 200 patients with normal ALT and chronic HBV infection admitted into Cangzhou Central Hospital from Feb.2020 to Feb.2024 were extracted.According to the content of serum HBV deoxyribonucleic acid(DNA),the virological response mode was divided into the complete virological response group(n=124)and partial virological response group(n=76).Demographic characteristic parameters,basic clinical conditions and laboratory indicators were collected.Logistic regression model was used to analyze the risk factors of partial virological response,the risk prediction model of partial virological response nomogramwas established,and the its effectiveness was verified.RESULTS:Compared with the complete virological response group,the proportion of positive HBeAg and“poor”medication compliance in the partial virological response group were higher,HBV DNA and HBsAg in the partial virological response group increased significantly,albumin decreased significantly,with statistically signficant differences(P<0.05);differences between two groups in body mass index,age,gender,family history of hepatitis B,history of hypertension,history of diabetes,type of antiviral medication,history of smoking and alcohol consumption,HBcAb,blood urea nitrogen,blood creatinine,blood uric acid,total bilirubin,alkaline phosphatase,triacylglycerol,total cholesterol,fasting blood glucose,white blood cell count,neutrophil count,platelet count,and liver stiffness values were not statistically significant(P>0.05).Logistic regression analysis showed that high HBV DNA level,high HBsAg level,positive HBeAg,low albumin level and“poor”medication compliance were the risk factors for partial virological response(P<0.05).A column chart risk model for partial virological response was constructed b

关 键 词：核苷(酸)类似物 丙氨酸转氨酶 慢性乙型肝炎病毒 病毒学应答 预测因素 列线图预测模型 

分 类 号：R978.7[医药卫生—药品]