摘要
目的探讨乙型肝炎病毒(HBV)前基因组核糖核酸(pgRNA)水平与慢性乙型肝炎患者停药后复发风险的相关性。方法选取2017年5月至2019年5月武汉市金银潭医院接受治疗且符合停药标准的慢性乙型肝炎患者224例,随访观察2年,采用Kaplan-Meier法绘制患者停药后累积复发曲线,同时根据是否复发分为复发组和非复发组。收集两组一般资料、实验室检查资料,荧光定量聚合酶链反应检测HBV感染患者的血清HBV pgRNA水平。采用Cox回归分析影响慢性乙型肝炎患者停药后复发风险相关因素,采用限制性立方条图拟合HBV pgRNA水平与慢性乙型肝炎患者停药后复发风险的非线性关系。结果随访2年,共6例因各种原因失访,最终纳入218例(复发组70例,非复发组148例),累积复发率为32.11%(70/218)。两组ALT、停药时有无抗-HBe对比差异有统计学意义。复发组HBV DNA为(4.23±1.09)lg拷贝/mL、停药时HBsAg为(2.36±0.71)lg IU/mL、HBV pgRNA水平为(4.55±1.32)lg拷贝/mL均显著高于非复发组的HBV DNA(3.71±1.02)lg拷贝/mL、停药时HBsAg(1.82±0.21)lg IU/mL、HBV pgRNA水平(4.06±1.23)lg拷贝/mL(均P<0.05)。Cox回归分析显示,HBV pgRNA水平(HR=1.235,95%CI:1.064~1.432)、ALT(HR=1.011,95%CI:1.006~1.016)、停药时HBsAg水平(HR=3.623,95%CI:2.348~5.591)、HBV DNA(HR=1.384,95%CI:1.099~1.743)为慢性乙型肝炎患者停药复发的危险因素(均P<0.05);限制性立方条图显示,HBV pgRNA水平与慢性乙型肝炎患者停药复发风险呈显著非线性关系(χ^(2)=24.710,P<0.01)。结论HBV pgRNA水平与慢性乙型肝炎患者停药复发风险相关。
Objective To investigate the corrrelation between the level of hepatitis B virus(HBV)pregenomic ribonucleic acid(pgRNA)and the risk of recurrence in patients with chronic hepatitis B(CHB)after withdrawal of antiviral drug.Methods A total of 224 patients with CHB treated in our hospital and meeting the discontinuation criteria from May 2017 to May 2019 were enrolled.They were followed up for 2 years.The Kaplan-Meier method was used to draw the cumulative recurrence curve of patients after drug withdrawal.Patients were divided into recurrence group and non-recurrence group according to whether relapse.Their general data,laboratory examination data,and serum HBV pgRNA level(detected by fluorescence quantitative polymerase chain reaction)were collected.COX regression analysis was used to analyze the related risk factors of the recurrence,and the restricted cubic spline was used to fit the nonlinear relationship between HBV pgRNA level and the risk of recurrence in patients with CHB after drug withdrawal.Results All the patients were followed up for 2 years,6 cases were lost due to various reasons,and 218 cases were finally enrolled(70 cases in the recurrence group and 148 cases in non-recurrence group),and the cumulative recurrence rate was 32.11%(70/218).The alanine transaminase(ALT)level and the HBeAb negative rate when stopping medication between the 2 groups were significantly different.The HBV DNA load[(4.23±1.09)lg copies/mL],the HBsAg level at the time of drug withdrawal[(2.36±0.71)lgIU/mL],and the HBV pgRNA level[(4.55±1.32)lg copies/mL]of recurrence group were significantly higher than those of non-recurrence group[HBV DNA load:(3.71±1.02)lg copies/mL,HBsAg level:(1.82±0.21)lgIU/mL,HBV pgRNA level:(4.06±1.23)lg copies/mL](all P<0.05).Cox regression analysis showed that HBV pgRNA level(HR=1.235,95%CI 1.064~1.432),ALT level(HR=1.011,95%CI 1.006~1.016),HBsAg level at the time of drug withdrawal(HR=3.623,95%CI 2.791~6.557)and HBV DNA load(HR=1.384,95%CI 1.099~1.743)were risk factors for relapse in patients with CHB after drug withdrawal(all P<0.05).Restricted cubic spline showed that there was a significant non-linear relationship between HBV pgRNA level and the risk of relapse in patients with CHB(χ^(2)=24.710,P<0.001).Conclusion The HBVpgRNA level is related to the relapse in patients with CHB after drug withdrawal.
作者
陈靖赜
祁玮
胡明乐
李华东
王静
CHEN Jing-yu;QI Wei;HU Ming-le;LI Hua-dong;WANG Jing(Department of Pharmacy,Wuhan Jinyintan Hospital,Hubei 430023,China;Department of Hepatology,Wuhan Jinyintan Hospital,Hubei 430023,China)
出处
《肝脏》
2022年第4期413-417,425,共6页
Chinese Hepatology
基金
湖北省卫生计生西医类一般项目(WJ2015MB166)。
