HBsAg对恩替卡韦治疗HBeAg阳性慢性乙型肝炎临床疗效的预测价值

The value of HBsAg in predicting the clinical efficacy of entecavir in the treatment of HBeAg-positive chronic hepatitis B

目的:探讨HBsAg预测恩替卡韦(ETV)治疗HBeAg(+)慢性乙型肝炎(CHB)疗效的价值。方法:研究对象为2018年1月至2019年6月中国人民解放军联勤保障部队第九二八医院住院接受ETV治疗(0.5 mg/d)的CHB患者104例,并对1年治疗情况进行随访;收集每例研究对象第0、3、6、9、12个月共5个时间点的血清样本,检测HBsAg、HBeAg浓度、血清HBV DNA载量及ALT水平,进行统计分析并绘制ROC曲线。结果:经过1年ETV治疗,发生病毒学应答(VR+组)68例,未发生病毒学应答(VR-组)36例;基线期VR+组患者HBV DNA水平明显低于VR-组(P<0.05);HBsAg浓度和ALT水平无明显差别(P>0.05);HBsAg与HBV DNA含量正相关(P=0.02);与治疗前比较,治疗3个月时,VR+组患者HBsAg水平下降幅度大于VR-组[(0.31±0.04)vs(0.15±0.02)lg IU/ml](P=0.028);且lg HBsAg在3.86 lg IU/ml时Youden指数最大(0.602),敏感度与特异度分别是82.7%和78.1%。结论:ETV治疗3个月时lg HBsAg≤3.86 IU/ml可作为预测CHB患者ETV治疗1年病毒学应答的指标。

Objective:To explore the value of HBsAg in predicting the efficacy of entecavir(ETV) in the treatment of HBeAg(+) chronic hepatitis B(CHB).Methods:The subjects of the study were 104 CHB patients who were hospitalized with entecavir treatment(0.5 mg/d) at the 928 th Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army from January 2018 to June 2019, and followed up for one year of treatment;Collect serum samples of each subject at 0, 3, 6, 9 and 12 months at 5 time points;detect HBsAg, HBeAg concentration, serum HBV DNA load and ALT level;perform statistical analysis and draw ROC curve. Results:After 1 year of ETV treatment, 68 cases of virological response(VR+ group) occurred, 36 cases of virological response did not occur(VR-group);baseline ALT levels were not significantly different between VR+ group and VR-group(P>0.05);HBV DNA VR+ group was significantly lower than VR-group(P<0.05);HBsAg concentration was not significantly different between VR+ group and VR-group(P>0.05);HBsAg and HBV DNA content were positively correlated(r=0.45, P=0.02): and Before treatment, at 3 months of treatment, the HBsAg decrease in VR+ group was greater than that in VR-group[(0.31±.0.04) vs(0.15±0.02)lg IU/ml](t=2.352,P=0.028);3 treatments At 3.865 0 lg IU/ml in the month, the Youden index was the largest(0.602), and the sensitivity and specificity were 82.7% and 78.1%, respectively. Conclusion:The lg HBsAg≤3.865 0 IU/ml at 3 months of ETV treatment can be used as an index to predict the virological response of ETV treatment at 1 year.