新疆地区使用核苷(酸)类似物抗病毒治疗的慢性乙型肝炎患者中表面抗原定量的应用及其影响因素分析

Application of Hepatitis B Virus Surface Antigen Quantification and Its Impact Factors in Patients with Chronic Hepatitis B during Nucleot(s)ide Analogues Treatment from Xinjiang

目的探索在新疆多民族聚居、人群背景因素复杂的情况下,乙型肝炎表面抗原(HBsAg)作为抗病毒疗效评价指标的应用价值及影响因素。方法回顾性分析新疆医科大学附属中医医院肝病科2012年1月-2013年8月期间住院就诊并初次使用核苷(酸)类似物进行治疗的慢性乙型肝炎(慢乙肝)患者临床资料,分析患者接受治疗后病毒学、血清学、生化学的变化情况,并分析其与HBsAg下降情况的关系,及治疗过程中HBsAg下降情况受影响的因素。结果共纳入乙型肝炎病毒慢性感染者63例。治疗48周时,所有患者均维持生化学应答,59例获得病毒学应答,另有4例获得部分病毒学应答,在其中的30例乙型肝炎e抗原(HBe Ag)阳性患者中,5例出现HBe Ag血清学转换。相关及回归分析结果显示病史(P=0.033)与治疗48周时的HBe Ag水平(P<0.001)为48周时的HBsAg水平的独立影响因素,而48周时HBsAg的下降程度受48周HBsAg水平的独立影响。21例治疗至72周的患者均维持了生化学应答,其中18例患者获得了病毒学应答,其余3例患者仍维持部分病毒学应答。8例HBe Ag阳性患者均未发生HBe Ag抗原消失或者血清学转换。相关及回归分析结果显示72周时HBsAg的水平受48周HBsAg水平影响(r=0.700,P<0.001),而72周HBsAg下降程度受基线HBsAg的影响。结论慢乙肝患者接受核苷(酸)类似物进行抗病毒治疗可以获得满意疗效。HBsAg单独作为患者接受抗病毒治疗时肝内共价闭合环状DNA(ccc DNA)的衡量指标需要考虑病史、HBe Ag的变化、HBsAg自身变化等因素的影响,并非只与肝内ccc DNA有关。

Objective To study the value of hepatitis B virus surface antigen （HBsAg） in the evaluation of antiviral efficacy and its influencing factors under a complex population background resulting from various nationalities in Xin）iang. Methods We retrospectively analyzed patients with chronic hepatitis B （CHB） admitted and administrated with nucleot（s）ide analogues （NAs） for the first time in Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region from January 2012 to August 2013. The biological, virological, and serological responses were analyzed as well as the possible factors related to HBsAg levels and its reduction levels. Results There were 63 CHB patients enrolled. After 48 weeks＇ treatment, all patients achieved biological response, and 59 of them achieved complete virological response in spite of 4 patients with partial response. In all the 30 hepatitis B virus e antigen （HBeAg） positive patients, 5 achieved HBeAg seroconversion. After correlation and regression analysis, it turned out that the history （P=0.033） and HBeAg levels at week 48 （P 〈 0.001） were independent impact factors for HBsAg level at week 48. And the reduction degree of HBsAg at week 48 was influenced by HBsAg at week 48. In 21 patients counting to week 72 maintaining biological response, 18 achieved complete virological response. Unfortunately, all 8 HBeAg positive patients encountered no HBeAg loss or seroconversion. After correlation and regression analysis, it turned out that HBsAg level at week 72 was influenced by HBsAg at week 48 （r=0.700, P 〈 0.001）. And the decline degree of HBsAg at week 72 was related to baseline HBsAg level. Conclusions Satisfactory efficacy can be achieved via NAs treatment in CHB patients. But when HBsAg is used separately as an indicator for therapeutic efficacy, we should be aware that intrahepatic covalently closed circular DNA （cccDNA） is not only the impact factor of HBsAg variation, the history, the variations of HBeAg and HBsAg itself during the treatment should also be considered.