慢性HBV感染患者血清pgRNA的表达及意义

Expression of serum pgRNA in patients with chronic HBV infection and its significance

目的 研究慢性乙型肝炎病毒(HBV)感染患者血清HBV前体基因组RNA(pgRNA)的表达及意义。方法 选择2019年10月1日-2020年9月30日就诊于南通大学附属医院感染科门诊和住院患者中的慢性HBV感染患者350例为研究对象。所有患者分为未治疗组(自然病程组)218例和治疗组132例;未治疗组分为4个亚组:免疫耐受期(IT)50例、免疫清除期(EPIA)53例、免疫控制期(ICH)78例和再活动期(ENH)37例;治疗组分为乙肝病毒e抗原(HBeAg)(+)103例,HBeAg(-)115例。收集患者临床资料,检测血清pgRNA的表达情况。结果 在未治疗组中HBV pgRNA水平有差异(P<0.05),其中IT组最高、ICH组最低,IT组与ICH、ENH组比较有统计学差异(P<0.05),EPIA组与ICH、ENH组有差异(P<0.05);同时结果显示各组间HBV DNA水平越高,HBV pgRNA水平越高;慢性乙型病毒性肝炎(CHB)、肝硬化(LC)、肝癌组(HCC)HBV pgRNA表达水平没有差异;HBsAg <100 IU/ml与≥100 IU/ml比较无统计学差异;HBeAg(+)组的HBV pgRNA水平高于HBeAg(-)组,两组比较有统计学差异(P<0.05)。在治疗组中,HBV pgRNA水平HBsAg<100 IU/ml组与≥100 IU/ml组比较无统计学差异;HCC组与CHB、LC组比较无统计学差异;根据治疗时间及HBeAg状态分组,HBV pgRNA水平没有差异。结论 慢性HBV感染不同自然病程中的各阶段外周血HBV pgRNA复制水平存在差异;HBV pgRNA水平可以预测慢性HBV感染的自然病程;血清HBV pgRNA可鉴别HBeAg(-)乙肝病毒再活动状态。

OBJECTIVE To explore the expression of serum HBV precursor genomic RNA(pgRNA) in patients with hepatitis B virus(HBV) infection and analyze its significance. METHODS A total of 350 patiens with chronic HBV infection who were treated in outpatient department and hospitalized in The Affiliated Hospital of Nantong University from Oct 1, 2019 to Sep 30, 2020 were recruited as the study subjects and divided into the untreated group( the natural course group) with 218 cases and the treatment group with 132 cases. There were 4 subgrups in the untreated group: 50 cases of immune tolerance period(IT), 53 cases of immune clearance period(EPIA), 78 cases of immune control period(ICH) and 37 cases of reactivation period. There were 103 cases of hepatitis B virus e antigen(HBeAg)(+) and 115 cases of HBeAg(-) cases in the treatment group. The clinical data were collected from the patients, and the expression of serum pgRNA was detected. RESULTS There was significant difference in the HBV pgRNA level among the three subgrups of the untreated group(P<0.05), with the highest in the IT group, the lowest in the ICH group, and there was significant difference between the IT group and the ICH group(P<0.05), and there was significant difference between the EPIA group and the ICH group(P<0.05). The higher the HBV DNA level, the higher the HBV pgRNA level was;there was no significant difference in the expression level of HBV pgRNA among the CHB patients, the liver cirrhosis(LC) patients and the hepatic carcinoma(HCC) group;there was no significant difference between the patients with HBsAg less than 100 IU/ml and the patients with HBsAg no less than 100 IU/ml. The HBV pgRNA level of the HBeAg(+) group was higher than that of the HBeAg(-) group, and there was significant difference(P<0.05). In the treatment group, there was no significant difference in the HBV pgRNA level between the patiens with HBsAg less than 100 IU/ml and the patients with HBsAg no less than 100 IU/ml;there was no sisngificant difference between the HCC group and the CHB group, the LC group. The patients were grouped according to the treatment time and state of HBeAg, there was no significant difference in the HBV pgRNA level. CONCLUSION There is significant difference in the replication level of peripheral blood HBV pgRNA during the natural courses of chronic HBV infection. The HBV pgRNA can predict the natural course of chronic HBV infection. Serum HBV pgRNA can distinguish the reactivation status of HBeAg(-) hepatitis B virus.