初次接受恩替卡韦治疗的CHB患者血清HBV pgRNA、HBcrAg水平动态观察

Dynamic observation of serum HBV pgRNA and HBcrAg in CHB patients treated with entecavir

目的观察初次接受恩替卡韦治疗的慢性乙型肝炎(CHB)患者乙型肝炎病毒新型血清标志物乙型肝炎病毒前基因RNA(HBV pgRNA)、乙型肝炎核心相关抗原(HBcrAg)水平的动态变化,同时探讨其与患者病情及HB⁃sAg、HBV DNA水平的关系。方法初次使用恩替卡韦抗HBV治疗并随访48周的CHB患者105例,治疗前,采用PCR法检测患者外周血中pgRNA,采用ELISA法检测HBcrAg,同时收集血清HBsAg、HBV DNA等资料。用Pearson相关分析血清HBV pgRNA、HBcrAg水平与CHB患者病情之间以及血清HBV pgRNA、HBcrAg与HBV DNA、HBsAg水平之间的相关性。结果CHB组患者在治疗第12、24、48周时HBV pgRNA、HBcrAg、HBsAg及HBV DNA水平较治疗前下降(P均<0.05),CHB患者血清HBV pgRNA、HBcrAg、HBsAg、HBV DNA在治疗各时段间两两比较,P均<0.05。治疗前,与HBeAg(-)的CHB患者比较,HBeAg(+)的CHB患者HBV pgRNA、HBcrAg水平高,但差异无统计学意义(P>0.05);治疗后,两组HBV pgRNA、HBcrAg水平均下降(P均<0.05),以HBeAg(+)CHB组为著(P均<0.05)。随着病情程度加重,CHB患者血清HBV pgRNA及HBcrAg水平下降(P均<0.05),CHB轻度患者血清HBV pgRNA水平较CHB中度及CHB重度患者高(P均<0.05);血清HBV pgRNA、HBcrAg水平与CHB病情程度呈负相关(P均<0.05)。CHB患者治疗前血清HBV pgRNA水平与HBcrAg、HBsAg及HBV DNA水平呈正相关(P均<0.05);血清HBcrAg水平与HBsAg及HBV DNA水平呈正相关(P均<0.05);CHB患者治疗后血清HBV pgRNA水平与HB⁃crAg、HBsAg、HBV DNA水平呈正相关(P均<0.05),血清HBcrAg水平与HBsAg、HBV DNA水平呈正相关(P均<0.05)。结论CHB患者血清HBV pgRNA、HBcrAg水平随恩替卡韦治疗时间延长呈下降趋势,HBeAg(+)的CHB患者下降更明显;血清HBV pgRNA、HBcrAg水平与患者病情程度及HBsAg、HBV DNA水平有关。

Objective To observe the dynamic changes of hepatitis B virus previral RNA(HBV pgRNA)and hepati⁃tis B core associated antigen(HBcrAg)levels in patients with chronic hepatitis B(CHB)treated with entecavir,and to ex⁃plore their relationships with the patients'condition and the levels of HBsAg and HBV DNA.Methods The pgRNA and HBcrAg in the peripheral blood of 105 CHB patients who were treated with entecavir for anti-HBV for the first time and fol⁃lowed up for 48 weeks were detected by PCR and ELISA,and the data of serum HBsAg and HBV DNA were collected.Pearson correlation was used to analyze the correlations between serum HBV pgRNA and HBcrAg levels and the condition of CHB patients,as well as between serum HBV pgRNA and HBcrAg levels and HBV DNA and HBsAg levels.Results The levels of HBV pgRNA,HBcrAg,HBsAg and HBV DNA in the CHB group at the 12th,24th and 48th weeks of treat⁃ment decreased compared with those before treatment(all P<0.05).Statistically significant differences were found in the serum HBV pgRNA,HBcrAg,HBsAg and HBV-DNA in CHB patients between each period of treatment(all P<0.05).Before treatment,HBV pgRNA and HBcrAg levels in HBeAg(+)CHB patients were higher than those in HBeAg(-)CHB patients,but the differences were not statistically significant(all P>0.05).After treatment,the levels of HBV pgRNA and HBcrAg decreased in both groups(all P<0.05),especially in the HBeAg(+)CHB group(all P<0.05).With the ag⁃gravation of disease,serum HBV pgRNA and HBcrAg levels in CHB patients decreased(all P<0.05),and serum HBV pgRNA levels in mild CHB patients were higher than those in moderate and severe CHB patients(all P<0.05).Serum HBV pgRNA and HBcrAg levels were negatively correlated with the severity of CHB(both P<0.05).Before treatment,se⁃rum HBV pgRNA levels were positively correlated with HBcrAg,HBsAg and HBV DNA levels(all P<0.05).Serum HB⁃crAg levels were positively correlated with HBsAg and HBV DNA levels(all P<0.05).After treatment,serum HBV pgRNA levels were positively correlated with HBcrAg,HBsAg and HBV DNA levels(all P<0.05),and serum HBcrAg levels were positively correlated with HBsAg and HBV DNA levels(all P<0.05).Conclusions The serum HBV pgRNA and HBcrAg levels in CHB patients decrease over the course of entecavir treatment,and decrease more obviously in CHB patients with HBeAg(+).The levels of serum HBV pgRNA and HBcrAg are related to the degree of disease and the levels of HBsAg and HBV DNA.