血清 HBV-RNA 检测在慢性乙型肝炎抗病毒治疗中的应用

Application of serum HBV-RNA detection in antiviral therapy for chronic hepatitis B

摘要

目的 探讨血清乙肝病毒核糖核酸(hepatitis B virus-RNA, HBV-RNA)检测在慢性乙型肝炎(chronic hepatitis B, CHB)和乙肝肝硬化患者核苷(酸)类似物(NAs)治疗监测中的临床应用价值。方法 以98例未抗病毒治疗和236例接受NAs治疗48～56周的患者为研究对象,按照乙肝病毒感染后疾病进展分为CHB组和乙肝肝硬化组,对所有研究对象同步检测血清乙肝病毒脱氧核糖核酸(hepatitis B virus-DNA,HBV-DNA)、HBV-RNA、乙肝表面抗原(HBsAg)、乙肝e抗原(HBeAg)以及谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(GGT)和碱性磷酸酶(ALP),比较未抗病毒组与NAs治疗组HBV-DNA/RNA水平的差异；在NAs治疗后,比较HBV-DNA/RNA在CHB组和肝硬化组阳性率的差异；进一步分析HBV-RNA阳性结果的影响因素。结果 NAs治疗后,HBV-DNA和HBV-RNA水平均低于治疗前(Z=-16.094和-12.399,P＜0.05)；NAs治疗后,无论在CHB组还是在肝硬化组,HBV-RNA阳性率均高于HBV-DNA(χ²=12.623和37.703,P＜0.05)。单因素分析结果显示,ALT、HBV-DNA、HBsAg、HBeAg、肝病进展与HBV-RNA阳性有关(P＜0.05)；多因素Logistic回归分析结果显示,肝病进展、HBsAg、HBeAg是HBV-RNA阳性的危险因素(OR=2.613、2.771和5.239,P＜0.05)。结论 血清HBV-RNA检测在预测HBV感染后肝脏受损状况以及判断抗病毒治疗停药时机方面有一定的临床应用价值。

Abstract

Objective To evaluate the clinical utility of serum HBV-RNA measurement for monitoring nucleotide analogue (NAs) therapy in patients with chronic hepatitis B (CHB) and liver cirrhosis. Methods A total of 98 untreated patients and 236 patients treated with NAs for 48-56 weeks were enrolled. According to post-infection disease stage, they were classified into CHB or cirrhosis groups. All the participants underwent simultaneous testing for serum HBV-DNA, HBV-RNA, HBsAg, HBeAg, ALT, AST, GGT, and ALP. HBV-DNA/RNA levels were compared between the untreated and NAs-treated cohorts. After NA therapy, the positive rates of HBV-DNA and HBV-RNA were compared between the CHB and cirrhosis groups. Factors associated with HBV-RNA positivity were analyzed. Results After NAs therapy, both HBV-DNA and HBV-RNA levels fell significantly versus the baseline (Z= -16.094 and -12.399, respectively；P＜0.05). Post-treatment, the HBV-RNA positivity rate was higher than that of HBV-DNA in both the CHB and cirrhosis groups (χ ²=12.623 and 37.703, respectively； P＜0.05). Univariate analysis showed that ALT, HBV-DNA, HBsAg, HBeAg, and disease stage were related to HBV-RNA positivity (P＜0.05). Multivariate Logistic regression identified disease stage, HBsAg, and HBeAg as independent risk factors for HBV-RNA positivity (OR =2.613, 2.771 and 5.239, respectively； P＜0.05). Conclusion Serum HBV-RNA testing is clinically valuable for assessing liver injury after HBV infection and for helping determine the optimal timing to discontinue antiviral therapy.

关键词

NAs治疗 / HBV-RNA / 慢性乙型肝炎(CHB) / 乙肝肝硬化

Key words

NAs therapy / HBV-RNA / chronic hepatitis B (CHB) / cirrhosis

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基金资助

陕西省科技攻关项目(2023-YBSF-411)