血清CYP2R1对核苷类似物/IFN-α治疗CHB疗效的预测价值

Serum CYP2R1 pair nucleoside analogues/IFN-αpredictive value of efficacy in the treatment of CHB

目的 探讨血清细胞色素P450家族2亚家族R成员1(CYP2R1)水平对核苷类似物(NAs)/干扰素-α(IFN-α)治疗慢性乙型肝炎(CHB)疗效的预测价值。方法 选取78例既往接受NAs治疗的CHB患者为CHB组,均给予聚乙二醇干扰素(Peg-IFN-α-2a)治疗48周(前8周联用恩替卡韦),根据抗病毒疗效分为应答组和非应答组;另选取40例健康志愿者为对照组。比较CHB组与对照组、应答组与非应答组CYP2R1水平,ROC评估CYP2R1预测抗病毒疗效的价值。结果 CHB组治疗前血清CYP2R1低于对照组,治疗12、24周应答组CYP2R1高于非应答组(P<0.05)。Logistic回归分析显示治疗前HBV DNA载量、25(OH)D3及治疗12、24周CYP2R1水平是影响抗病毒疗效的独立危险因素(P<0.05)。治疗12周CYP2R1预测抗病毒疗效的ROC曲线下面积(AUC)为0.673,灵敏度为60.42%,特异度为70.00%,治疗24周分别为0.774、72.92%、83.33%,治疗24周较12周血清CYP2R1预测抗病毒疗效效能高(P<0.05)。结论 NAs/IFN-α治疗过程中CHB患者CYP2R1水平变化与IFN-α抗病毒疗效有关,治疗24周的CYP2R1水平可作为预测IFN-α抗病毒疗效敏感指标。

Aim To investigate the relationship between serum cytochrome P450 family 2 subfamily R member 1(CYP2R1)level and the clinical efficacy of nucleoside analogs(NAs)/interferon-α(IFN-α)in the treatment of chronic hepatitis B(CHB).Methods 78 patients with CHB who had previously received NAs therapy were selected as the research group,and they were all given pegylated interferon(Peg-IFN-α-2a)for 48 weeks(the first 8 weeks combined with entecavir),divided into response group and non-response group according to antiviral efficacy.Another 40 healthy volunteers were selected as the control group.The CYP2R1 levels of the study group and the control group,the response group and the non-responder group were compared.The predictive value of CYP2R1 on IFN-αantiviral efficacy was eval-uated by receiver operating characteristic(ROC)curve.Results The serum CYP2R1 in the study group before IFN-αtreatment was lower than that in the control group,and the CYP2R1 in the response group was higher than that in the non-response group,after 12 and 24 weeks of treatment(P<0.05).Logistic regression analysis showed that HBV DNA load before treatment,25(OH)D3 and CYP2R1 levels at 12 and 24 weeks after treatment were independent risk factors for antiviral efficacy(P<0.05).The area under the ROC curve(AUC)of CYP2R1 predicting antiviral efficacy at 12 weeks of treatment was 0.673,the sensitivity was 60.42%,and the specificity was 70.00%,and 24-weektreatment were 0.774,72.92%,83.33%.The efficacy of serum CYP2R1 in predicting antiviral efficacy was higher at 24 weeks of treatment than at 12 weeks(P<0.05).Conclusion The change of CYP2R1 level in CHB patients during NAs/IFN-αtreatment is related to the antiviral efficacy of IFN-α,and the CYP2R1 level at 24 weeks of treatment can be used as a sen-sitive indicator to predict the antiviral efficacy of IFN-α.