基线血清HBV RNA水平对TDF治疗CHB合并进展期肝纤维化/代偿期肝硬化患者HBeAg血清学转换的预测价值  

Predictive value of baseline serum HBV RNA levels for HBeAg seroconversion in chronic hepatitis B patients with advanced fibrosis/compensated cirrhosis undergoing tenofovir disoproxil fumarate treatment

作　　者：张海莹[1] 王震宇 贾玉缘 陈红松[1] 饶慧瑛[3] Zhang Haiying;Wang Zhenyu;Jia Yuyuan;Chen Hongsong;Rao Huiying(Peking University People′s Hospital,Peking University Hepatology Institute,Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases,Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis,Beijing100044,China;Infectious Disease and Hepatology Center of Peking University People′s Hospital,Beijing100044,China;Peking University People′s Hospital,Department of Hepatology,Beijing100044,China)

机构地区：[1]北京大学人民医院、北京大学肝病研究所、丙型肝炎和肝病免疫治疗北京市重点实验室、非酒精性脂肪性肝病诊断北京市国际科技合作基地,北京100044 [2]北京大学人民医院感染与肝病中心,北京100044 [3]北京大学人民医院肝病科,北京100044

出　　处：《中华检验医学杂志》2025年第1期49-55,共7页Chinese Journal of Laboratory Medicine

摘　　要：目的评估基线血清指标乙型肝炎病毒(HBV)RNA对富马酸替诺福韦酯(TDF)治疗慢性乙型肝炎(CHB)合并进展期肝纤维化/代偿期肝硬化患者乙型肝炎e抗原(HBeAg)血清学转换的预测价值。方法选取2015年1月至2020年12月在北京大学人民医院检测并经TDF治疗的CHB合并进展期肝纤维化/代偿期肝硬化患者141例,进行回顾性病例对照研究。根据治疗240周时是否发生HBeAg血清学转换,将研究对象分为HBeAg血清学转换组(16例)和未转换组(59例)。根据基线和治疗12周的HBeAg结果,将研究对象分为HBeAg阳性组(分别为75、61例)和阴性组(分别为66、80例)。检测基线各相关指标水平,用基线、240周剩余血清检测HBV RNA水平。采用Pearson法分析HBV RNA与HBV DNA的相关性,受试者工作特征(ROC)曲线评价预测价值。结果75例HBeAg阳性患者中,21.3%(16/75)发生HBeAg血清学转换。基线HBeAg阳性组HBV DNA、HBV RNA水平均高于HBeAg阴性组(P均<0.001);HBeAg血清学转换组基线HBV RNA水平明显低于HBeAg血清学未转换组(P<0.05)。Pearson相关分析显示,在基线或12周HBeAg阴性组、HBeAg阳性组血清HBV RNA水平与HBV DNA均呈正相关(基线:r=0.718、0.794,P均<0.001;12周:r=0.689、0.750,P均<0.001)。ROC曲线显示,基线HBV RNA水平预测CHB合并进展期肝纤维化/代偿期肝硬化患者TDF治疗HBeAg血清学转换的曲线下面积为0.781,敏感度为75.0%,特异度为78.0%。结论基线血清HBV RNA水平对TDF治疗的CHB合并进展期肝纤维化/代偿期肝硬化患者HBeAg血清学转换具有预测价值。ObjectiveTo explore the predictive value of baseline serum levels of hepatitis B virus(HBV)RNA for HBeAg seroconversion in chronic hepatitis B(CHB)subjects with advanced fibrosis/compensated cirrhosis undergoing tenofovir disoproxil fumarate(TDF)therapy.MethodsA case-control study was conducted on 141 patients with CHB combined with advanced fibrosis/compensated cirrhosis who were treated with TDF and tested at Peking University People′s Hospital from January 2015 to December 2020.Patients were divided into HBeAg seroconversion(16 cases)group and non-seroconversion(59 cases)group based on whether HBeAg seroconversion occurred at 240 weeks after treatment.The patients were divided into HBeAg positive and negative groups at baseline(75 and 66 cases,repectively)and at 12 weeks treatment(61 and 80 cases,repectively).The baseline serum levels of relevant indicators were analyzed.HBV RNA levels were measured at baseline and at 240 weeks after treatment.The correlation between HBV RNA and HBV DNA was analyzed using Pearson correlation analysis,and the predictive value was evaluated using the receiver operating characteristic(ROC)curve.ResultsFor the 75 HBeAg-positive patients at baseline,21.3%(16/75)achieved HBeAg seroconversion.The HBV DNA and HBV RNA in the HBeAg-positive group were significantly higher than that in the HBeAg-negative group(all P<0.001).Compared with the non-seroconversion group,the HBeAg seroconversion group had significantly lower baseline serum levels of HBV RNA(P<0.05).Pearson correlation analysis showed that serum HBV RNA levels were positively correlated with HBV DNA in both baseline and 12 weeks HBeAg-negative group and HBeAg-positive group,respectively(baseline:r=0.718,0.794,P<0.001;12 weeks:r=0.689,0.750,P<0.001).ROC curve showed that baseline levels of HBV RNA could be used as a predictor of HBeAg seroconversion in CHB patients with advanced fibrosis/compensated cirrhosis treated with TDF.The area under curve was 0.781,the sensitivity was 75.0%,and the specificity was 78.0%.ConclusionBasel

关 键 词：慢性乙型肝炎 肝纤维化 代偿期肝硬化 核苷类似物 HBV前基因组RNA 乙型肝炎e抗原 血清学转换 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]