核苷(酸)类似物治疗代偿期乙型肝炎肝硬化患者血清HBV RNA水平变化及临床意义

Changes and clinical value of serum HBV RNA levels on patients with compensatory hepatitis B cirrhosis treated with nucleos(t)ide analogues

目的探讨核苷(酸)类似物[nucleos(t)ide analogues,NAs]治疗代偿期乙型肝炎肝硬化患者过程中患者血清HBV RNA水平变化及临床意义。方法选择2012年7月至2014年6月首都医科大学附属北京地坛医院接受NAs治疗的51例代偿期乙型肝炎肝硬化的患者为研究对象,分别检测治疗前及治疗182周时丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、乙型肝炎病毒表面抗原(hepatitis B virus surface antigen,HBsAg)、乙型肝炎病毒e抗原(hepatitis B virus e antigen,HBeAg)、乙型肝炎病毒e抗体(hepatitis B virus e antibody,HBeAb)、HBVDNA及血清HBVRNA水平,采用Spearman相关分析血清HBV RNA水平与ALT、HBsAg、HBV DNA水平的相关性。结果(1)接受NAs治疗182周时,血清ALT(中位数:19.7 U/L vs 58.1 U/L)、AST(中位数:20.9 U/L vs 47.0 U/L)及HBs Ag(3.13±0.43 log10IU/ml vs 3.38±0.40 log10IU/ml)水平较基线显著降低,差异有统计学意义(P均<0.05),HBV DNA阴转率为93.62%(44/47)。(2)接受NAs治疗182周时血清HBV RNA水平与基线差异无统计学意义[(3.86±1.07)log10IU/ml vs(4.22±1.28)log10IU/ml;t=1.56,P=0.13]。(3)治疗182周时,HBe Ag未阴转组与阴转组(中位数:3.2 log10IU/ml vs 3.5 log10IU/ml)、HBe Ag未发生血清学转换组与发生转换组(中位数:3.2 log10IU/ml vs 3.5 log10IU/ml)间血清HBV RNA水平差异均无统计学意义(P均>0.05)。(4)患者基线血清HBV RNA与ALT、HBs Ag、HBV DNA水平均无相关性(r=0.14,P=0.36;r=0.05,P=0.75;r=0.05,P=0.77)。结论血清HBV RNA水平变化在代偿期乙型肝炎肝硬化患者NAs抗病毒治疗效果评估及预测方面无明显意义。

Objective To investigate the changes and clinical value of serum HBV RNA levels on patients with compensatory hepatitis B cirrhosis treated with nucleos(t)ide analogues(NAs).Methods A total of 51 patients with compensatory hepatitis B cirrhosis who received NAs treatment in Beijing Ditan Hospital,Capital Medical University from July 2012 to June 2014 were selected.Alanine aminotransferase(ALT)level,aspartate aminotransferase(AST)level,hepatitis B virus surface antigen(HBsAg),hepatitis B virus e antigen(HBeAg),hepatitis B virus e antibody(HBeAg),hepatitis B virus e antibody(HBeAb),HBV DNA level and HBV RNA level were detected before and after 182 weeks of NAs treatment.Spearman correlation analysis was used to investigate the correlations between serum HBV RNA level and HBsAg,ALT level and HBV DNA level.Results①The serum level of ALT(median:19.7 U/L vs 58.1 U/L),AST(median:20.9 U/L vs 47.0 U/L)and HBsAg(3.13±0.43 log10 IU/ml vs 3.38±0.40 log10 IU/ml)of patients at 182 weeks after treatment reduced significantly compared with those of baseline,the differences were statistically significant(all P<0.05).The negative conversion rate of HBV DNA was 93.62%(44/47).②There was no statistical difference in serum HBV RNA level of patients between baseline and 182 weeks after treatment[(3.86±1.07)log10 IU/ml vs(4.22±1.28)log10 IU/ml;t=1.56,P=0.13].③There was no statistically significant difference in serum HBV RNA level between patients with and without negative conversion of HBeAg(median:3.2 log10 IU/ml vs 3.5 log10 IU/ml;P>0.05),and there was no statistically significant difference in serum HBV RNA level between HBeAg seroconversion group and non-seroconversion group(median:3.2 log10 IU/ml vs 3.5 log10 IU/ml;P>0.05).④There were no correlations between baseline serum HBV RNA level and ALT level,HBsAg,HBV DNA level of the patients(r=0.14,P=0.36;r=0.05,P=0.75;r=0.05,P=0.77).Conclusions The changes of serum HBV RNA level had no significance on evaluating or predicting the efficacy of NAs antiviral therapy in patients with compensatory hepatitis B cirrhosis.