HBeAg阳性及阴性患者血清HBV RNA水平与乙肝相关肝纤维化情况的相关性分析

Analysis on the correlation between serum HBV RNA level and hepatitis B related hepatic fibrosis in HBeAg positive and negative patients

目的探讨HBeAg阳性及阴性患者血清HBV RNA水平对乙肝相关肝纤维化的影响,为早期肝纤维化诊断和预测提供新方案。方法选取2016年10月至2019年9月我院确诊的乙肝病毒感染的患者145例作为研究对象,进行HBV DNA、HBV RNA水平的检测;通过肝活检及相关生化指标评定肝纤维化分级、炎症分级和肝脏储备能力;通过多因素Logistic回归分析,明确独立危险因素;通过ROC曲线评价HBV RNA水平对乙肝相关肝纤维化预测的影响。结果HBeAg阳性患者的AST、ALT和HBV DNA定量均显著高于HBeAg阴性患者,差异有统计学意义(P<0.05);在HBeAg阳性和阴性患者中,HBV RNA阳性组的肝纤维化分级、炎症分级和Child-Pugh分级均显著高于HBV RNA阴性组,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,HBeAg阳性和阴性患者的肝纤维化分级、炎症分级和Child-Pugh分级是影响HBV RNA的独立危险因素(P<0.05);ROC曲线和效能评估检测发现,HBV RNA评估HBeAg阴性患者肝纤维化分级和炎症分级的曲线下面积(AUC)分别为0.721和0.763,特异度分别为69.5%和73.5%,敏感度为73.8%和75.4%。结论HBV RNA与乙肝肝纤维化具有相关性,对HBeAg阴性患者具有预测价值,值得临床推广。

Objective To investigate the impacts of serum hepatitis B virus(HBV)RNA level and hepatitis B related hepatic fibrosis in HBeAg positive and negative patients,and to provide a new scheme for early diagnosis and prediction of hepatic fibrosis.Methods A total of 145 patients with confirmed HBV infection from October 2016 to September 2019 were selected as the research objects,and HBV DNA and HBV RNA levels were detected.The levels of fibrosis,inflammation and liver reserve capacity were evaluated by liver biopsy and related biochemical indexes.Through multivariate Logistic regression analysis,the independent risk factors were identified.ROC curve was used to evaluate the impacts of HBV RNA level on the prediction of hepatitis B related hepatic fibrosis.Results The levels of AST,ALT and HBV DNA in HBeAg positive patients were all significantly higher than those in HBeAg negative patients,with statistically significant differences(P<0.05).In HBeAg positive and negative patients,the levels of hepatic fibrosis,inflammation and child-pugh in the HBV RNA positive group were significantly higher than those in the HBV RNA negative group,with statistically significant differences(P<0.05).It was shown by multivariate Logistic regression analysis that the levels of hepatic fibrosis,inflammation and child-pugh were independent risk factors of HBeAg positive and negative patients impacting HBV RNA(P<0.05).It was shown by ROC curve and efficacy evaluation that the area under the curve(AUC)of HBV RNA in evaluating the levels of hepatic fibrosis and inflammation in HBeAg negative patients was 0.721 and 0.763,the specificity was 69.5%and 73.5%,and the sensitivity was 73.8%and 75.4%(P<0.05).Conclusion HBV RNA is correlated with hepatitis B hepatic fibrosis,and has predictive value for HBeAg negative patients,which is worthy of clinical promotion.