乙肝不同临床阶段HBV RNA的动态变化及其临床意义

Dy namic changes of HBV RNA in different clinical stages of hepatitis B and its clinical significance

目的探讨乙肝不同临床阶段HBV RNA的动态变化,以及与HBsAg等指标的相关性。方法选取2021年1月至8月在本院门诊及住院部就诊的慢性乙型肝炎(CHB)患者129例,检测CHB患者血清HBV RNA,HBV DNA,乙肝三系,乙肝表面抗原定量,生化等指标,观察HBV感染者不同时期HBV RNA表达水平及与HBsAg定量的关系。结果慢乙肝、肝硬化代偿期、肝硬化失代偿期、肝癌患者HBV RNA阳性率分别为75.4%、57.1%、65%、75%。在HBV DNA<30 IU/mL患者中,HBV RNA检出率69.8%。HBV RNA定量在肝硬化失代偿期与CHB患者、肝硬化代偿期与CHB患者均存在显著差异,差异具有统计学意义(P<0.002),其余各组两两比较均不存在显著差异。HBV RNA与HBsAg呈正相关,相关系数r=0.334(P<0.001)。结论CHB患者在HBV DNA阴转后仍有大部分患者可以检测出HBV RNA,说明HBV RNA在反映肝内病毒复制活性方面要明显优于HBV DNA。在CHB的不同临床阶段,HBV RNA、HBsAg的表达水平不同,因此可以通过这些指标来预测疾病所处的阶段及预后。

Objective To explore the dynamic changes of HBV RNA in different clinical stages of hepatitis B and its correlation with HBsAg and other indicators.Methods A total of 129 patients with Chronic Hepatitis B(CHB)treated in the out-patient and in-patient departments of Xixi Hospital in Hangzhou from January 2021 to August 2021 were included in this study,Serum HBV RNA,HBV DNA,three lines of Hepatitis B in CHB patients,HBV surface antigen quantification,biochemistry and other indicators were detected to observe the HBV RNA expression level in different periods of HBV infection and the relationship with HBsAg quantification.Results The positive rates of HBV RNA in patients with chronic hepatitis B,compensatory stage of cirrhosis,decompensated stage of cirrhosis and liver cancer were 75.4%,57.1%,65%and 75%,respectively.In patients with HBV DNA<30 IU/mL,the positive rate of HBV RNA was 69.8%.There were significant differences in HBV RNA quantification between patients with decompensated cirrhosis and hepatitis with CHB,and between patients with decompensated cirrhosis and patients with CHB,and the differences were statistically significant(P<0.002),while there were no significant differences in other groups.HBV RNA was positively correlated with HBsAg,with correlation coefficient R=0.334,with statistical significance(P<0.001).Conclusion In CHB patients,HBV RNA can still be detected in most patients after HBV DNA negative transformation,indicating that HBV RNA is significantly superior to HBV DNA in reflecting viral replication activity in the liver.In different clinical stages of CHB,the expression levels of HBV RNA and HBsAg are different,so these indicators can be used to predict the stage,development direction and prognosis of the disease.