摘要
目的研究血清HBV共价闭合环状DNA(HBV cccDNA)、HBsAg、HBV前基因组RNA(HBV pgRNA)联合检测对恩替卡韦(ETV)治疗HBeAg阳性慢性乙型肝炎(CHB)患者的效果预测价值。方法将2015年5月-2017年5月经苏州大学附属第二医院确诊为HBeAg阳性的87例CHB患者纳入研究。根据患者ETV治疗48周后是否获得完全应答,分为获得组(n=38)和未获得组(n=49)。均采取ETV治疗,疗程48周,观测患者基线及治疗12、24、48周时血清HBV cccDNA、HBsAg、HBV pgRNA的水平。正态分布的计量资料组间比较采用t检验,非正态分布的采用Mann-Whitney U检验。计数资料组间比较采用χ2检验;等级资料组间比较采用Mann-Whitney U检验。采用Pearson相关分析探讨肝组织HBV cccDNA与血清HBsAg、HBV pgRNA的相关性。采用多因素logistic回归分析完全应答的预测因素,并采用受试者工作特征曲线(ROC曲线)评价血清HBV cccDNA、HBsAg、HBV pgRNA单独或联合检测对完全应答的预测价值。结果相较于未获得组,完全应答获得组患者基线,治疗24、48周时的HBV cccDNA水平明显下降(Z值分别为-2.452、-2.518、-2.266,P值均<0.001);基线,治疗12、24及48周时的HBsAg水平明显下降(Z值分别为-2.431、-2.750、2.386、2.536,P值均<0.001);治疗12、24、48周时的HBV pgRNA水平明显下降(Z值分别为-2.674、-2.503、-2.528,P值均<0.001)。完全应答获得组患者HBV cccDNA在治疗24周时、HBsAg在治疗12周时、HBV pgRNA在治疗12周时的下降水平均明显高于未获得组(Z值分别为-2.352、-2.566、-2.389,P值分别为0.006、0.001、0.004)。血清HBsAg、HBV pgRNA与肝组织HBV cccDNA均呈正相关(r值分别为0.553、0.757,P值均<0.001)。治疗24周时HBV cccDNA、治疗12周时HBsAg、治疗12周时HBV pgRNA的水平可作为预测完全应答的独立影响因素(OR分别为6.248、5.452、5.670,95%CI分别为1.574~14.262、2.048~16.888、1.201~16.183,P值均<0.05)。HBV cccDNA、HBsAg、HBV pgRNA的ROC曲线下面积值分别
Objective To investigate value of combined measurement of serum hepatitis B virus(HBV)covalently closed circular DNA(cccDNA),HBsAg,and HBV pregenomic RNA(pgRNA)in predicting the treatment outcome of HBeAg-positive chronic hepatitis B(CHB)patients treated with entecavir(ETV).Methods A total of 87 HBeAg-positive CHB patients who were diagnosed and treated in The Second Affiliated Hospital of Suzhou University from May 2015 to May 2017 were enrolled.All patients were treated with ETV for 48 weeks,and the serum levels of HBV cccDNA,HBsAg,and HBV pgRNA were measured at baseline and at weeks 12,24,and 48 of treatment.The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups.The chi-square test was used for comparison of categorical data between groups,and the Mann-Whitney U test was used for comparison of ranked data between groups.A Pearson correlation analysis was performed to determine the correlation of liver HBV cccDNA with serum HBsAg and HBV pgRNA.A multivariate logistic regression analysis was used to investigate the predictive factors for complete response,and the receiver operating characteristic(ROC)curve was used to evaluate the value of serum HBV cccDNA,HBsAg,and HBV pgRNA measured alone or in combination in predicting complete response.Results Of all 87 HBeAg-positive CHB patients after 48 weeks of ETV treatment,38 achieved complete response and 49 did not achieve complete response.Compared with the non-complete response group,the complete response group had significant reductions in the levels of HBV cccDNA at baseline and at weeks 24 and 48 of treatment(Z=-2.452,-2.518,and-2.266,all P<0.001),HBsAg at baseline and at weeks 12,24,and 48 of treatment(Z=-2.431,-2.750,-2.386,and-2.536,all P<0.001),and HBV pgRNA at weeks 12,24,and 48 of treatment(Z=-2.674,-2.503,and-2.528,all P<0.001).Compared with the non-complete response group,the complete response group had signifi
作者
王颖
赵奎
秦建忠
WANG Ying;ZHAO Kui;QIN Jianzhong(Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China)
出处
《临床肝胆病杂志》
CAS
北大核心
2020年第5期1008-1013,共6页
Journal of Clinical Hepatology
基金
江苏省自然青年科学基金项目(BK20160338)。
