核苷（酸）类抗病毒药物治疗慢性乙型肝炎患者HBVDNA与HBsAg定量的5年动态分析

Antiviral dynamic change of HBV DNA and HBsAg and significance of quarterly and annual quantitative measurements over 5-year follow-up of chronic hepatitis B patients

目的分析慢性乙型肝炎患者应用核苷（酸）类抗病毒药物治疗，动态观察HBVDNA与HBsAg定量。方法110例慢性乙型肝炎患者初始应用单种核昔类药物抗病毒治疗，每三个月随访一次，检测HBV五项标志物、HBVDNA，每隔1年检测HBsAg定量，用SPSSl3．0统计软件分析比较HBVDNA与HBsAg定量的5年变化。根据资料不同分别采用方差分析和x。检验进行统计学分析。结果110例患者中，在随访第5年仍有90例应用单药治疗。HBeAg阳性的HBVDNA与HBsAg定量均高于HBeAg阴性的患者。随着抗病毒治疗时间的延长，慢性乙型肝炎患者的HBsAg和HBVDNA均有下降趋势值分别为17．1和151．53，P值均〈0．05），HBVDNA在随访第1年下降最明显。结论HBeAg阴性和HBeAg阳性慢性乙型肝炎患者HBVDNA与HBsAg定量均随着核苷（酸）类抗病毒药物治疗时间的延长而下降；HBVDNA在治疗一年内下降幅度最大，HBsAg定量在随访后3年与基线水平比较，差异有统计学意义。

Objective To analyze the dynamic changes in hepatitis B virus （HBV） DNA and hepatitis B surface antigen （HBsAg） levels in chronic hepatitis B （CHB） patients following treatment by antiviral nucleotide drugs over a 5-year follow-up period and to assess the clinical significance of quarterly and annual quantitative measurements. Methods One-hundred-and-ten patients with CHB were enrolled in the study and administered on-going standard mono-therapy with various antiviral nucleotide drugs. Over a 5-year period, the HBV DNA level was measured by quantitative PCR every three months and the HBsAg levels were measured by chemiluminescence once a year. The dynamic changes in HBV DNA and HBsAg levels were assessed by Chi-squared test and ANOVA. Results Only 90 of the CHB patients completed the 5-year follow-up and were included in the analysis. The patients who showed HBeAg- positivity at baseline （study start） had higher levels of HBV DNA and HBsAg than the patients showing HBeAg negativity. In general, the antiviral nucleotide drug therapy induced downward trends in HBsAg and HBV DNA level over time （F = 17.1, 151.53, allP 〈 0.05）. However, the most robust reduction in HBV DNA occurred during the first year. The HBsAg level followed an opposite trend, with the most robust reductions occurring in the 3rd, 4thand 5th years oftrealment. Conclusion Long-term antiviral nucleotide mono-thempies induced decreases in HBV DNA and HBsAg levels in CHB patients, with the former being most reduced in the short-term and the latter in the long-term.