血清前白蛋白总胆红素比值水平评估慢性乙型肝炎恩曲他滨治疗耐药性的价值

The Value of Prealbumin/Total Bilirubin Ratio in the Evaluation of Emtricitabine Resistance in the Treatment of Chronic Hepatitis B

目的探讨血清前白蛋白(prealbumin,PA)/总胆红素(total bilirubin,TBiL)比值水平对评估慢性乙型肝炎(chronic hepatitisB,CHB)恩曲他滨治疗耐药性的价值。方法回顾性分析2017年5月至2018年5月于沈阳医学院附属中心医院接受恩曲他滨治疗的140例CHB患者的临床资料,按照是否产生恩曲他滨耐药性分为耐药组和对照组,其中耐药组67例,对照组73例。检测所有患者肝功能指标和血清病毒学指标,分析影响CHB患者恩曲他滨耐药性的因素,采用Cox多因素回归模型分析影响CHB患者恩曲他滨耐药性的独立因素以及PA/TBiL评估CHB患者恩曲他滨耐药性的价值。结果丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、TBiL、白蛋白(ALB)、PA、PA/TBiL、乙肝病毒的脱氧核糖核酸(HBV-DNA)、乙型肝炎病毒e抗原(HBeAg)与CHB患者恩曲他滨耐药性均有关(P<0.05),与性别、年龄、病程无关(P>0.05)。TBiL、PA、PA/TBiL是影响CHB患者恩曲他滨治疗耐药性的独立因素(P<0.05)。TBiL、PA、PA/TBiL评估CHB患者恩曲他滨治疗耐药性价值的曲线下面积分别为0.643、0.656、0.893。结论血清PA/TBiL比值水平对评估CHB患者恩曲他滨治疗耐药性具有重要的临床参考价值。

Objective To explore the value of prealbumin(PA)/total bilirubin(TBiL)ratio in the evaluation of emtricitabine resistance of chronic hepatitis B(CHB).Methods Retrospective analysis of clinical data was performed in 140 patients with CHB who received emtricitabine in the Affiliated Center Hospital of Shenyang Medical College from May 2015 to May 2016,and 140 CHB patients were divided into a drug resistance group and a control group according to whether they had emtricitabine resistance,including 67 patients in drug resistance group and 73 patients in control group.The liver function indexes and serum virological indexes of all patients before treatment were measured,and the factors influencing the drug resistance of emtricitabine in CHB patients were analyzed.The independent factors influencing the drug resistance of emtricitabine in CHB patients were analyzed by Cox multiple factor regression model,and the value of PA/TBiL in the drug resistance of emtricitabine in CHB patients was evaluated.Results ALT,AST,TBiL,ALB,PA,PA/TBiL,HBVDNA,HBeAg were associated with embritabine resistance in patients with CHB(P<0.05),and were not related to gender,age,and duration of disease(P>0.05).TBiL,PA,and PA/TBiL were independent factors affecting the drug resistance of emtricitabine in CHB patients(P<0.05).The area under the curve for the value of TBiL,PA,and PA/TBiL in evaluating the drug resistance of emtricitabine in CHB patients was 0.643,0.656 and 0.893 respectively.Conclusion PA/TBiL ratio level has important clinical reference value for evaluating emtricitabine treatment in CHB patients.