核苷(酸)类似物治疗丙氨酸转氨酶正常HBeAg阳性且HBV DNA高水平慢性乙型肝炎的有效性研究

A study of the effectiveness of nucleos(t)ide analogues in the treatment of HBeAg-positive chronic hepatitis B with normal alanine aminotransferase and high level of HBV DNA

目的探究丙氨酸转氨酶正常的HBeAg阳性且HBV DNA高水平的慢性乙型肝炎患者接受核苷(酸)类似物治疗的效果。方法收集2019年1月至2020年1月在四川大学华西医院感染性疾病中心治疗并随访的慢性乙型肝炎初治患者为对象,回顾性收集患者人口学特征、治疗前和治疗1年时的实验室检查结果,并根据患者服药种类不同分为富马酸替诺福韦二吡夫酯片(TDF)治疗组和丙酚替诺福韦(TAF)治疗组,分析和比较两组患者血清HBV DNA水平、HBeAg血清学转换和HBsAg定量水平的改变情况。结果共纳入38例患者,其中TDF组16例,TAF组22例;两组患者的人口学特征、基线HBV DNA水平和HBsAg定量水平差异无统计学意义。经过1年的抗病毒治疗,60.5%(23/38)的患者获得了病毒学应答。尽管TAF组较TDF组可以实现更高的血清HBV DNA低于检测值下限率[68.2%(15/22)比50.0%(8/16),P=0.258]和HBeAg血清学转换率[18.2%(4/22)比6.3%(1/16),P=0.374],但二者差异均无统计学意义;TDF和TAF治疗均可以明显降低患者血清HBsAg定量水平。此外,TAF治疗组患者出现丙氨酸转氨酶增高的情况低于TDF治疗组。多因素logistic回归分析结果显示患者年龄是抗病毒治疗获得病毒学应答的独立预测因素。结论丙氨酸转氨酶正常的HBeAg阳性且HBV DNA水平高的慢性乙型肝炎患者接受TDF和TAF治疗均可获得较好的疗效。

Objective To investigate the effectiveness of nucleos(t)ide analogues in the treatment of HBeAg-positive chronic hepatitis B with normal alanine aminotransferase and high level of HBV DNA.Methods Treatment-naïve chronic hepatitis B patients who were followed up at the Center of Infectious Diseases,West China Hospital of Sichuan University from January 2019 to January 2020 were selected as subjects.Demographic characteristics,the results of laboratory examination before treatment and one year after treatment were retrospectively collected.Patients were divided into tenofovir dipivoxil(TDF)and propofol fumurate tenofovir(TAF)treatment group according to different types of medication.The changes of serum HBV DNA level,HBeAg serological conversion and HBsAg quantitative level were analyzed and compared between the two groups.Results A total of 38 cases were enrolled.Among them,there were 16 and 22 cases in the TDF and TAF group,respectively.There was no statistically significant difference in demographic characteristics,baseline HBV DNA levels and HBsAg quantitative levels between the two groups.Virological response was achieved in 60.5%(23/38)of patients after one year of antiviral therapy.Serum HBV DNA levels below the lower limit of detection[68.2%(15/22)vs.50.0%(8/16),P=0.258]and higher HBeAg seroconversion rate[18.2%](4/22)vs.6.3%(1/16),P=0.374]was obtained in TAF than TDF group;however,there was no statistically significant differences between the two.Serum HBsAg quantitative level was significantly reduced with TDF and TAF treatment.In addition,alanine aminotransferase elevation was reduced in TAF than TDF treated group.Multivariate logistic regression analysis showed that patient age was an independent predictor of a virological response to antiviral therapy.Conclusion HBeAg-positive CHB patients with normal alanine aminotransferase,and high HBV DNA level can obtain better curative effect after TDF and TAF treatment.