慢性乙型肝炎和乙型肝炎肝硬化患者核苷(酸)类似物完全病毒学应答后血清乙型肝炎病毒核糖核酸检测及影响因素  

Detection and influencing factors of serum hepatitis B virus ribonucleic acid of patients with chronic hepatitis B and hepatitis B related cirrhosis who have achieved complete virological response after treatment with nucleos(t)ide analogues

作　　者：吴娟丽 张域爽 高涵 张毅恒 王磊[1] 曲云东[1] 李涛[1] Wu Juanli;Zhang Yushuang;Gao Han;Zhang Yiheng;Wang Lei;Qu Yundong;Li Tao(Department of Infection and Hepatology,The Second Hospital of Shandong University,Jinan 250033,China)

机构地区：[1]山东大学第二医院感染/肝病科,济南市250033

出　　处：《中华实验和临床感染病杂志(电子版)》2024年第6期343-349,共7页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的探讨核苷(酸)类似物(NAs)经治慢性乙型病毒性肝炎(CHB)和乙型肝炎肝硬化患者达到完全病毒学应答后血清乙型肝炎病毒(HBV)核糖核酸(RNA)仍可检测到的相关影响因素及特点。方法本研究为横断面研究,连续纳入2020年3月至2024年4月就诊于山东大学第二医院肝病科门诊的360例CHB和149例乙型肝炎肝硬化患者,均接受NAs治疗且达到完全病毒学应答,通过实时恒温扩增和检测技术(SAT)检测HBV RNA。根据HBV RNA是否低于检测下限将患者分为HBV RNA可测组(335例)和HBV RNA不可测组(174例)。应用多因素Logistic回归分析确定与血清HBV RNA可测的相关因素。在HBV RNA可测组中比较不同诊断、HBV e抗原(HBeAg)状态、HBV表面抗原(HBsAg)水平患者HBV RNA定量差异。结果HBeAg阳性患者血清HBV RNA阳性率为94.6%(157/166),高于HBeAg阴性患者的51.9%(178/343)(χ^(2)=90.582、P<0.001);HBV RNA可测组较HBV RNA不可测组患者HBsAg水平[3.1(2.6,3.6)log_(10)IU/ml]更高,差异有统计学意义(Z=-6.239、P<0.001)。多因素Logistic回归分析表明,乙型肝炎肝硬化(OR=2.305、95%CI:1.419~3.742、P=0.001)、HBeAg阳性(OR=14.852、95%CI:7.212~30.586、P<0.001)以及血清HBsAg>2.56 log_(10)IU/ml(OR=2.645、95%CI:1.654~4.232、P<0.001)均为血清HBV RNA可测的危险因素。结论NAs经治实现完全病毒学应答的患者中,乙型肝炎肝硬化、HBeAg阳性以及较高水平HBsAg均为血清HBV RNA可测的危险因素,在这部分患者进行HBV RNA检测有助于更全面评估病毒转录和复制状态。Objective To explore the influencing factors and distribution characteristics of detectable serum hepatitis B virus(HBV)ribonucleic acid(RNA)of patients with chronic hepatitis B(CHB)and hepatitis B related cirrhosis who were treated with nucleos(t)ide analogues(NAs)after achieving complete virological response.Method This cross-sectional study involved the consecutive enrollment of 360 patients with CHB and 149 patients with hepatitis B related cirrhosis who attended outpatients of the Department of Hepatology,the Second Hospital of Shandong University from March 2020 and April 2024,all patients received NAs treatment and achieved complete virological response;HBV RNA was detected by real-time thermostatic amplification and detection technology(SAT).Patients were divided into two groups based on whether HBV RNA was below the detection limit:HBV RNA detectable group(335 cases)and HBV RNA undetectable group(174 cases).The influencing factors with detectable serum HBV RNA were analyzed by Multivariate Logistic regression analysis.The quantitative differences of HBV RNA among cases with different diagnoses,HBV e antigen(HBeAg)status and HBV surface antigen(HBsAg)levels were compared in the patients of HBV RNA detectable group.Result The positive rate of serum HBV RNA of 166 patients with HBeAg positive was 94.6%(157/166),which was significantly higher than that of HBeAg negative patients[51.9%(178/343)](χ^(2)=90.582,P<0.001);compared with HBV RNA undetectable group,patients in HBV RNA detectable group were with higher HBsAg level[3.1(2.6,3.6)log_(10)IU/ml],with significant difference(Z=-6.239,P<0.001).Multivariate Logistic regression analysis showed that hepatitis B related cirrhosis(OR=2.305,95%CI:1.419-3.742,P=0.001),HBeAg positivity(OR=14.852,95%CI:7.212-30.586,P<0.001)and serum HBsAg>2.56 log_(10)IU/ml(OR=2.645,95%CI:1.654-4.232,P<0.001)were all risk factors for serum HBV RNA detectable.Conclusions Among patients who achieve complete virological response after NAs treatment,hepatitis B related cirrhosis,HBeAg po

关 键 词：病毒性肝炎 乙型 肝硬化 肝炎病毒 乙型 RNA 乙型肝炎病毒表面抗原 

分 类 号：R51[医药卫生—内科学]