血清HBV pgRNA在慢性乙型肝炎患者聚乙二醇化干扰素抗病毒过程中的临床价值

Clinical significance of HBV pgRNA in antiviral treatment with interferon for patients with chronic hepatitis B

目的通过动态观察慢性乙型肝炎患者抗病毒过程中HBV pgRNA、HBVDNA、血清学及生化学指标,探索HBVpgRNA在慢性乙型肝炎抗病毒过程中的临床意义,进一步探寻HBV pgRNA在抗病毒治疗终点的预测价值。方法纳入聚乙二醇化干扰素(Peg-IFN)抗病毒治疗的慢性乙型肝炎患者18例,疗程48周,分别在0、12、24、36和48周治疗节点上检测HBV pgRNA水平、HBVDNA水平、血清学和生化学指标,统计分析以上指标间的相关性。结果在Peg-IFN治疗过程中,无论ALT是否升高,患者HBVDNA和HBV pgRNA水平均呈下降趋势;在相关性分析中,HBVpgRNA水平与HBeAg有相关性(P<0.001),与HBsAg无相关性(P>0.05)。HBVDNA阳性患者,HBVDNA与HBV pgRNA呈显著正相关(P<0.01)。治疗时间是影响HBVpgRNA水平的独立影响因素,其他指标与HBVpgRNA无显著相关性(P>0.05);4.22%的患者在治疗的第24周时HBV pgRNA接近最低检测限时,HBsAg开始出现下降,并且在后24周的治疗过程中,HBsAg仍继续下降;而在治疗第24周时,如果HBVpgRNA≥103copies/ml,HBsAg基本无明显下降;而如果在治疗第24周时HBV pgRNA低于最低检测限,在后24周的治疗中,HBV pgRNA水平将持续在检测值以下。结论HBVpgRNA可能更好地反映干扰素抑制病毒复制的情况,同时对免疫学应答有预测作用,有助于治疗效果的判断,对指导个体化治疗具有一定的临床价值。但本研究的样本量少,仍需大样本进一步验证。

Objective Through the dynamic observation of HBV pgRNA, HBV DNA, serological and biochemical indicators in the antiviral process of patients with chronic hepatitis B, to explore the clinical significance of HBV pgRNA in the anti-viral process of chronic hepatitis B, and to further explore the HBV pgRNA at the end of antiviral therapy. Methods Eighteen patients with chronic hepatitis B were treated with pegylated interferon antiviral therapy (Peg-IFN) for 48 weeks. The HBV pgRNA levels, HBV DNA levels, and serological and biochemical indicators were tested at 0, 12, 24, 36 and 48 weeks of the treatment. The correlation among the above indicators was statistically analyzed. Results During the Peg-IFN treatment, the HBV DNA and HBV pgRNA levels decreased. The HBV pgRNA levels correlated with HBeAg (P < 0.001), but not with HBsAg (P>0.05). HBV DNA was positively correlated with HBV pgRNA in the HBV DNA-positive patients (P<0.01). The treatment time was affected by HBV pgRNA. There were no significant correlations between the levels of independent influencing factors and other indicators (P > 0.05). In 4.22% of the patients, the HBsAg began to decrease at the 24th week of the treatment and when HBV pgRNA was close to the minimum detection limit, and had been declining for the last 24 weeks. At the 24th week of treatment, if HBV pgRNA ≥ 10^3 copies/ml, there was no significant decrease in HBsAg;and if HBV pgRNA was below the minimum detection limit at week 24 of treatment, the HBV pgRNA levels would continue to be below the test value during the last 24 weeks of treatment. Conclusion HBV pgRNA may better reflect the inhibition of viral replication by interferon, and has a predictive effect on immunological response, which is helpful for the judgment of therapeutic efficacy and has certain clinical value for guiding individualized treatment. However, the sample size of this study is small, and large samples are still needed for further verification.