摘要
目的探讨核苷(酸)类似物(NAs)初治的慢性乙型肝炎(CHB)患者发生低病毒血症(LLV)的影响因素,并进一步分析其动态变化。方法选取2020年11月—2022年3月于南昌大学第一附属医院感染科门诊就诊且接受NAs抗病毒治疗至少12个月的CHB患者78例,根据治疗期间的HBV DNA水平,将患者分为持续病毒学应答(SVR)组(n=58)和LLV组(n=20)。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验,计数资料两组间比较采用χ^(2)检验或Fisher精确检验;多因素Logistic回归分析CHB患者发生LLV的独立影响因素,并建立预测模型。采用受试者工作特征曲线(ROC曲线)评价模型的预测价值。使用Kaplan-Meier分析HBV DNA累积阴转率,应用Log-rank检验进行比较。采用重复测量方差分析比较两组间或组内0、12、24、36、48周HBV DNA和HBsAg水平及其变化的差异。结果LLV组HBeAg阳性率(90.0%vs 48.3%,χ^(2)=10.701,P=0.001)、HBV DNA log值(7.26±1.46 vs 5.65±1.70,t=-4.178,P<0.001)、HBsAg log值(4.53±0.86 vs 3.44±0.93,t=-4.813,P<0.001)高于SVR组,年龄[29(26~34)岁vs 33(30~43)岁,Z=-2.751,P=0.009]、ALT[67.0(54.0~122.0)U/L vs 111.0(47.0~406.0)U/L,Z=-2.203,P=0.028]、AST[43.5(32.8~62.8)U/L vs 77.5(35.0~213.0)U/L,Z=-2.466,P=0.014]、LSM[7.7(6.3~8.5)kPa vs 8.9(7.2~11.4)kPa,Z=-2.022,P=0.043]低于SVR组。多因素Logistic回归分析显示,基线HBV DNA(OR=2.365,95%CI:1.220~4.587,P=0.011)、HBsAg(OR=4.229,95%CI:1.098~16.287,P=0.036)和ALT(OR=0.965,95%CI:0.937~0.994,P=0.018)是CHB患者发生LLV的独立影响因素;由此建立预测模型Logit(MLLV)=-8.668+1.441×lgHBsAg+0.598×lgHBV DNA-0.016×ALT,其ROC曲线下面积为0.931,高于HBV DNA、HBsAg和ALT(ROC曲线下面积分别为0.774、0.856、0.666),最佳截断值为0.44,敏感度、特异度分别为85.00%、93.10%。基线HBV DNA>7.29 lgIU/mL和HBsAg>4.38 lgIU/mL的CHB患者HBV DNA阴转率明显低于HBV DNA≤7.29 lgIU/mL和HBsAg≤4.38 lgIU/mL的患者(χ^(2)值分别为22.52、26.35,P值均<0.001)。
Objective To investigate the influencing factors for low-level viremia(LLV)and their dynamic changes in chronic hepatitis B(CHB)patients treated with nucleos(t)ide analogues(NAs)for the first time.Methods A retrospective analysis was performed for 78 CHB patients who attended Department of Infectious Diseases,The First Affiliated Hospital of Nanchang University,from November 2020 to March 2022 and received antiviral therapy with NAs for at least 12 months,and according to HBV DNA level during treatment,they were divided into sustained virologic response(SVR)group with 58 patients and LLV group with 20 patients.The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.The multivariate Logistic regression analysis was used to investigate the independent influencing factors for LLV and establish a predictive model,and the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of this model.The Kaplan-Meier method was used to analyze cumulative HBV DNA negative conversion rate,and the Log-rank test was used for comparison.The analysis of variance with repeated measures was used to analyze the differences in HBV DNA and HBsAg between the two groups or within each group at weeks 0,12,24,36,and 48.Results Compare with the SVR group,the LLV group had significantly higher HBeAg positive rate(90.0%vs 48.3%,χ^(2)=10.701,P=0.001),log(HBV DNA)value(7.26±1.46 vs 5.65±1.70,t=-4.178,P<0.001),and log(HBsAg)value(4.53±0.86 vs 3.44±0.93,t=-4.813,P<0.001)and significantly lower age[29(26-34)vs 33(30-43),Z=-2.751,P=0.009],alanine aminotransferase(ALT)[67.0(54.0-122.0)U/L vs 111.0(47.0-406.0)U/L,Z=-2.203,P=0.028],aspartate aminotransferase[43.5(32.8-62.8)U/L vs 77.5(35.0-213.0)U/L,Z=-2.466,P=0.014],and liver stiffness measurement[7.7(6.3-8.5)kPa vs 8.9(7.2-11.4)kPa,Z=-2.022,P=0.043].The multivariate logistic regression analy
作者
程齐齐
杨丽霞
蔡天盼
王亮
孙俊
梁佳圆
刘丽萍
甘厦
阮宁杭
葛善飞
CHENG Qiqi;YANG Lixia;CAI Tianpan;WANG Liang;SUN Jun;LIANG Jiayuan;LIU Liping;GAN Xia;RUAN Ning-hang;GE Shanfei(Department of Infectious Diseases,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Information Center,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Clinical Medicine College,Nanchang University,Nanchang 330031,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2022年第12期2716-2722,共7页
Journal of Clinical Hepatology
基金
江西省自然科学基金面上项目(20192BAB205090)。
关键词
乙型肝炎
慢性
低病毒血症
预测
Hepatitis B
Chronic
Low-level Viremia
Forecasting
