慢性乙型肝炎病人经核苷(酸)药物治疗后血清HBV pgRNA的检测及其临床意义

陈慧娟; 李伟; 陈家盛; 刘传苗; 吴取梅; 汪蔷华

doi:10.13898/j.cnki.issn.1000-2200.2023.07.013

慢性乙型肝炎病人经核苷(酸)药物治疗后血清HBV pgRNA的检测及其临床意义

Detection and clinical significance of serum HBV pgRNA in patients with chronic hepatitis B treated with nucleoside/nucleotide analogues

摘要

摘要:
目的观察慢性乙型肝炎(CHB)病人使用恩替卡韦(ETV)或富马酸替诺福韦酯(TDF)抗病毒治疗后血清乙型肝炎病毒(HBV)前基因组RNA(pgRNA)水平的变化，及其与HBsAg、HBV DNA的关系，以探讨HBV pgRNA在抗病毒治疗中的临床意义。
方法选取89例初治CHB病人，其中44例接受ETV治疗(ETV组)，45例接受TDF治疗(TDF组)。在治疗前、治疗24周、48周时随访，检测病人的血清HBsAg、HBV DNA、HBV pgRNA水平，分析2组病人血清HBV pgRNA水平的变化趋势和差异，以及HBV pgRNA与HBsAg、HBV DNA间的相关性。
结果随着治疗时间的延长，2组病人HBV pgRNA水平均明显降低(P < 0.01)。2组病人治疗24周时HBV pgRNA水平低于治疗前(P < 0.05)，治疗48周时HBV pgRNA水平低于治疗24周时(P < 0.05)。在抗病毒治疗前及治疗24周、48周时，ETV组病人的HBV pgRNA水平与HBsAg水平均呈明显正相关关系(P < 0.01)，HBV pgRNA水平与HBV DNA亦呈明显正相关关系(P < 0.01)。在抗病毒治疗前、治疗24周、48周时，TDF组病人的HBV pgRNA与HBsAg均呈明显正相关关系(P < 0.01)；抗病毒治疗前、治疗24周时，TDF组病人的HBV pgRNA与HBV DNA呈明显正相关关系(P < 0.01)，但抗病毒治疗48周时，病人的HBV pgRNA与HBV DNA无明显相关关系(P>0.05)。TDF组病人HBV DNA的阴转率高于同一时间点ETV组病人，在治疗48周时，2组间差异有统计学意义(χ²=6.23，P < 0.05)。
结论CHB病人血清HBV pgRNA水平在抗病毒治疗的进程中呈明显下降趋势，血清HBV pgRNA在核苷(酸)药物抗病毒疗效评估与监测方面有一定的临床意义。

Abstract:
ObjectiveTo observe the changes of serum hepatitis B virus (HBV) pregenomic RNA (pgRNA) levels in patients with chronic hepatitis B (CHB) after antiviral therapy with entecavir (ETV) or tenofovir disoproxil fumarate (TDF), and its relationship with HBsAg and HBV DNA, so as to explore the clinical significance of HBV pgRNA in antiviral therapy.
MethodsA total of 89 newly diagnosed CHB patients were selected, including 44 patients receiving ETV treatment (ETV group) and 45 patients receiving TDF treatment (TDF group).The patients were followed up before treatment, at 24 weeks and 48 weeks of treatment, and the serum levels of HBsAg, HBV DNA, HBV pgRNA were measured, the changes and differences in serum HBV pgRNA levels between the two groups were analyzed, as well as the correlation between HBV pgRNA and HBsAg, HBV DNA.
ResultsWith the prolongation of treatment time, the HBV pgRNA levels of patients in the two groups significantly decreased (P < 0.01).At 24 weeks of treatment, the HBV pgRNA levels of patients in the two groups were lower than those before treatment (P < 0.05), and at 48 weeks of treatment, the HBV pgRNA levels were lower than those at 24 weeks of treatment (P < 0.05).Before antiviral treatment and at 24 weeks and 48 weeks of treatment, the HBV pgRNA levels were significantly positively correlated with HBsAg levels in the ETV group (P < 0.01), and HBV pgRNA levels were also significantly positively correlated with HBV DNA (P < 0.01).Before antiviral treatment and at 24 weeks and 48 weeks of treatment, the HBV pgRNA levels were significantly positively correlated with HBsAg levels in the TDF group (P < 0.01);before antiviral treatment and at 24 weeks of treatment, the HBV pgRNA levels were significantly positively correlated with HBV DNA in the TDF group (P < 0.01), but the HBV pgRNA levels were not significantly correlated with HBV DNA in the TDF group at 48 weeks of treatment (P>0.05).The negative conversion rate of HBV DNA of patients in the TDF group was higher than that in the ETV group at the same time point, and at 48 weeks of treatment, there was a statistically significant difference between the two groups (P < 0.05).
ConclusionsThe serum HBV pgRNA levels of CHB patients show a significant downward trend during the process of antiviral treatment, and serum HBV pgRNA has certain clinical significance in evaluating and monitoring the antiviral efficacy of nucleos(t)ide analogues.

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