血清HBsAg滴度反映恩替卡韦治疗乙型肝炎肝硬化合并原发性肝癌患者病毒应答的临床价值

Clinical value of HBsAg titer reflecting virological response of Entecavir treating chronic hepatitis B liver cirrhosis with primary hepatic carcinoma

目的探讨血清HBsAg滴度的动态变化反映恩替卡韦（ETV）治疗慢性乙型肝炎肝硬化合并原发性肝癌患者病毒学应答的价值。方法回顾性分析2011年10月-2014年10月在吉林大学第四医院接受ETV（0.5 mg/d）治疗的乙型肝炎肝硬化合并原发性肝癌患者62例的临床资料,随访48周。治疗12周,按照患者是否发生病毒学应答分为病毒应答组和非病毒应答组,其中,病毒应答组40例,非病毒应答组22例。比较抗病毒治疗24、36、48周患者的血清乙型肝炎病毒表面抗原（HBsAg）滴度、谷丙转氨酶（ALT）和HBV DNA的变化情况。ROC曲线预测患者的病毒学应答和确定最佳临界值。结果治疗24周时,病毒应答组患者血清HBsAg低于非病毒应答组（P〈0.05）;治疗36、48周,病毒应答组与非病毒应答组HBsAg水平差异无统计学意义（P〉0.05）;治疗24、36、48周,病毒应答组ALT与非病毒应答组相近,差异无统计学意义（P〉0.05）。治疗24、36、48周,病毒应答组HBV DNA低于非病毒应答组,差异有统计学意义（P〈0.05）。在HBsAg为3.42 lg U/m L时（最佳临界值）,对应的约登（Youden）指数（0.631）最大,可以作为预测48周病毒学应答的指标,其诊断敏感度为85.1%,特异度为78.1%。结论 Hbs Ag可以作为ETV治疗48周发生病毒学应答的判断指标。

Objective To discuss the clinical value of HBsAg titer reflecting virological response of Entecavir treating chronic hepatitis B liver cirrhosis with primary hepatic carcinoma. Methods From October 2011 to October 2014, in the Forth Hospital of Jilin University, the clinical data of 62 patients with Entecavir treating chronic hepatitis B liver cirrhosis with primary hepatic carcinoma were retrospectively analyzed, they were follow-up for 48 weeks. According to whether got virological response, they were divided into virological response group（40 cases） and non-virological response group（22 cases）. HBsAg titer, ALT, HBV DNA of patients at 24, 36, 48 weeks after antiviral therapy were compared. ROC curve was used for predicting virological response of patients and ensuring the best cut-off. Results Treating for 24 weeks, HBsAg of virological response group was lower than that of non-virological response group（P〈0.05）. Treating for 36, 48 weeks, there were no differences in HBsAg between the two groups（P〉0.05）. Treating for 24,36, 48 weeks, ALT levels of virological response group were close to non-virological response group（P〉0.05）. Treating for 24, 36, 48 weeks, HBV DNA levels of virological response group were lower than those of non-virological response group（P〈0.05）. When HBsAg was 3.43 lg U/m L（the best cut off）, Youden index（0.632） was the biggest, which can be taken as a predicting virological response index in 48 week treatment, the sensitivity was 85.1%, the specificity was78.1%. Conclusion Hbs Ag can be taken as the estimate index of virological response for ETV treatment for 48 weeks.