经NAs长期治疗的慢性乙型肝炎患者HBV RNA的水平及其临床意义

Level and clinical significance of HBV RNA in patients with chronic hepatitis B treated by NAs for a long time

目的探讨经核苷类似物(NAs)长期治疗的慢性乙型肝炎(CHB)患者乙型肝炎病毒(HBV)RNA的水平及其临床意义。方法选取2023年6月至2024年2月在该院接受NAs治疗2年及以上的81例CHB患者作为研究对象。对所有患者进行HBV RNA、HBV DNA定量检测。比较不同HBV DNA水平患者HBV RNA定量水平;比较不同乙型肝炎E抗原(HBeAg)水平患者HBV RNA定量水平;比较不同乙型肝炎表面抗原(HBsAg)水平患者HBV RNA定量水平;分析年龄、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、HBeAg、HBsAg、HBV DNA与HBV RNA定量水平的相关性。结果HBV DNA>10 IU/mL组(45例)和HBV DNA<10 IU/mL组(36例)HBV RNA定量水平分别为3.31(2.31,3.95)、0(0.00,2.31),HBV DNA>10 IU/mL组明显高于HBV DNA<10 IU/mL组,差异有统计学意义(P<0.05)。HBeAg阳性组(37例)和HBeAg阴性组(44例)HBV RNA定量水平分别为3.37(2.31,3.66)、2.11(0.00,2.48),HBeAg阳性组HBV RNA定量水平明显高于HBeAg阴性组,差异有统计学意义(P<0.05)。HBsAg<200 IU/mL组(9例)、200 IU/mL<HBsAg<2000 IU/mL组(35例)、HBsAg≥2000 IU/mL组(37例)HBV RNA定量水平分别为0.00(0.00,2.03)、2.25(0.00,2.75)、3.21(2.29,4.33),3组间HBV RNA定量水平比较,差异有统计学意义(P<0.05)。HBV RNA定量水平与HBsAg、HBeAg及HBV DNA水平均呈显著正相关(r=0.513、0.321、0.508,P<0.05)。结论CHB患者中HBV RNA水平与HBV DNA、HBsAg、HBeAg水平关系密切,当HBV DNA低于检测下限时,应该进一步检测血清中的HBV RNA水平。

Objective To investigate the level and clinical significance of hepatitis B rivus(HBV)RNA in patients with chronic hepatitis B(CHB)who have undergone long-term nucleoside analogues(NAs)treatment.Methods A total of 81 patients with CHB who received NAs treatment in Juye County People's Hospital for 2 years or more from June 2023 to February 2024 were selected as the study subjects.Quantitative testing of HBV RNA and HBV DNA were performed on all patients.The quantitative levels of HBV RNA in patients with different levels of HBV DNA were compared.The quantitative levels of HBV RNA in patients with different levels of hepatitis B E antigen(HBeAg)were compared.The quantitative levels of HBV RNA in patients with different hepatitis B surface antigen(HBsAg)levels were compared.The correlation between age,alanine aminotransferase(ALT),aspartate aminotransferase(AST),HBeAg,HBsAg,HBV DNA and HBV RNA quantitative levels were analyzed.Results The quantitative levels of HBV RNA in the group with HBV DNA>10 IU/mL(45 cases)and the group with HBV DNA<10 IU/mL(36 cases)were 3.31(2.31,3.95)and 0.00(0.00,2.31)respectively,which in the group with HBV DNA>10 IU/mL was significantly higher than that in the group with HBV DNA<10 IU/mL,and the difference was statistically significant(P<0.05).The quantitative levels of HBV RNA in the HBeAg positive group(37 cases)and the HBeAg negative group(44 cases)were 3.37(2.31,3.66)and 2.11(0.00,2.48)respectively,the quantitative level of HBV RNA in the HBeAg positive group was significantly higher than those in the HBeAg negative group,and the difference was statistically significant(P<0.05).The quantitative levels of HBV RNA in the HBsAg<200 IU/mL group(9 cases),200 IU/mL<HBsAg<2000 IU/mL group(35 cases),HBsAg≥2000 IU/mL group(37 cases)were 0.00(0.00,2.03),2.25(0.00,2.75),and 3.21(2.29,4.33)respectively,the differences in HBV RNA quantitative levels among the three groups were statistically significant(P<0.05).The quantitative level of HBV RNA correlated significantly positively with the levels of HBsAg,HBeAg and HBV DNA(r=0.513,0.321,0.508,P<0.05).Conclusion The expression level of HBV RNA in CHB patients relates closely to the levels of HBV DNA,HBsAg and HBeAg.When HBV DNA is below the detection limit,further detection of the level of HBV RNA in serum should be carried out.