外周血淋巴细胞和单核细胞比值与替比夫定治疗基因B型慢性乙型肝炎早期病毒学应答的相关性分析

Correlations between Peripheral Blood LMR and Early Virological Response in the Treatment of Type B Chronic Hepatitis B with Telbivudine

目的观察分析外周血淋巴细胞与单核细胞比值(LMR)与替比夫定治疗基因B型慢性乙型肝炎(CHB)早期病毒学应答的相关性。方法选取本院2016年6月-2017年4月收治的82例CHB患者进行研究,所选患者均给予替比夫定治疗,回顾性分析患者的临床资料,检测所选患者的AST、ALT、TBil、LMR和HBV DNA等相关指标水平,同时观察记录其病毒和早期病毒学应答情况,分析不同资料间的相关性。结果随着治疗时间的延长,患者的ALT复常率、HBV DNA不可测率、HBeAg阴转率、HBeAg血清转换率、血清TBil及AST水平均得到明显改善(P<0.05)。所选患者的年龄与HBV DNA下降幅度呈明显负相关(P<0.05),HBeAg、LMR、ALT、AST、基线HBV DNA水平与HBV DNA下降幅度呈明显正相关(P<0.05);调整年龄、性别、HBeAg及治疗时间后发现,LMR、ALT、AST、基线HBV DNA水平仍与HBV DNA下降幅度呈明显正相关(P<0.05)。单因素分析结果显示,应答组患者的家族史、AST、ALT、TBil、LMR和HBV DNA水平均与未应答组患者存在明显差异(P<0.05)。多因素Logisitic回归分析发现,有家族史、血清TBil和LMR高水平及HBV DNA水平过高均是导致B型CHB患者未能出现早期病毒学应答的独立危险因素(P<0.05)。结论 LMR与替比夫定治疗基因B型CHB患者,其HBV DNA含量是预测基因B型CHB患者早期病毒学应答出现的重要指标。

Objective To investigate the correlations between peripheral blood lymphocyte to monocyte ratio（ LMR） and early virological response during the treatment of type B chronic hepatitis B with telbivudine. Methods Eighty-two cases of genotype B CHB treated in our hospital between June 2016 and April 2017 were selected as subjects and were given telbivudine treatment. The clinical data on these patients was retrospectively analyzed. The levels of AST,ALT,TBil,LMR,and HBV DNA of these patients were detected while virus and early virological responses were observed and recorded. The correlations between different data were analyzed. Results The recovery rate of ALT,non-measurable rate of HBV DNA,negative conversion rate of Hbe Ag,and conversion rate of HBeAg serum of patients were significantly improved（ P〈0. 05） at 12 wk,24 wk and 48 wk after treatment,and there were significant changes in the serum levels of TBil and AST after treatment（ P〈0. 05）. The age of patients showed significant negative correlations with the decrease of HBV DNA（ P〈0. 05）,while HBeAg,LMR,ALT,AST,and base line HBV DNAlevels showed significant positive correlations with the decline of HBV DNA（ P〈0. 05）. In order to keep off the influence of confounding factors,age,gender,HBeAg and treatment time were adjusted,but the LMR,ALT,AST,baseline HBV DNA levels still showed significant positive correlations with the decrease of HBV DNA（ P〈0. 05）. Single factor analysis showed significant difference in the levels of FH,AST,ALT,TBil,LMR,and HBV DNA between the response group and the non response group（ P〈0. 05）. The multivariate Logistic regression analysis showed that family history,high serum levels of TBil,LMR and HBV DNA were independent risk factors that make it impossible for patients with genotype B CHB to develop EVR（ P〈0. 05）. Conclusion When LMR and telbivudine are used for treating patients with genotype B CHB,the HBV DNA content is ane important indicator to predict the occurrence of EVR.