HBeAg阳性慢性乙型肝炎低病毒血症患者HBV RNA状态及干预后变化

doi:10.6040/j.issn.1671-7554.0.2024.1035

摘要/Abstract

摘要： 目的探讨核苷(酸)类似物(nucleoside/nucleotide analogues, NAs)治疗后乙型肝炎e抗原(hepatitis B e antigen, HBeAg)阳性慢性乙型肝炎低病毒血症(low-level viremia, LLV)患者的血清乙型肝炎病毒RNA(hepatitis B virus RNA, HBV RNA)水平及其在NAs干预后的变化。方法采用巢式病例对照研究,根据LLV病例数1∶1匹配抗病毒治疗后达到维持病毒学应答(maintained virological response, MVR)患者。共纳入62例LLV及62例MVR患者。根据患者治疗意愿将LLV患者分为NAs维持治疗组及更改方案组,收集其临床资料并进行随访。通过实时荧光恒温扩增检测技术(simultaneous amplification and testing, SAT)对血清HBV RNA进行定量检测。结果与MVR组患者相比,LLV组在基线、随访24周及48周时血清HBV RNA水平均较高(P均<0.001)。随访期间LLV患者血清HBV RNA水平较基线有所下降,差异无统计学意义(P均>0.05)。LLV患者在维持治疗组和更改方案组随访至24、48周时血清HBV RNA变化幅度仅在更改方案组的48时有所下降,差异无统计学意义(P均>0.05)。结论与MVR组相比,LLV患者血清HBV RNA水平更高且下降缓慢,调整NAs治疗后HBV RNA水平较维持方案组下降并不明显,提示需要联合其它干预措施以进一步降低HBV转录活性。

关键词: 低病毒血症, 维持病毒学应答, 乙型肝炎病毒RNA, 核苷(酸)类似物, 乙型肝炎e抗原

Abstract: Objective To investigate serum HBV RNA levels in HBeAg-positive chronic hepatitis B patients with low-level viremia(LLV)following long-term nucleoside/nucleotide analogues(NAs)therapy and to assess changes after NAs intervention. Methods This was a nested case-control study and patients with LLV were matched 1∶1 with who achieved a maintained virological response(MVR)after antiviral therapy. LLV patients were then categorized into an NAs intervention group and a control group based on their willingness to undergo further treatment. Clinical data were collected and followed up. Serum HBV RNA was quantified using the Specific RNA Target Capture combined with the Simultaneous Amplification and Testing(SAT)method. Results A total of 62 LLV patients and 62 MVR patients were enrolled. Serum HBV RNA levels are higher in the LLV group compared with the MVR group at baseline, 24 weeks and 48 weeks of follow-up(P<0.001). During the follow-up period, serum HBV RNA decreased from baseline in the LLV patients, but the results were not statistically different. The decrease in serum HBV RNA changes in LLV patients in the control and intervention groups followed up to 24 and 48 weeks only decreased in the intervention group at 48 weeks, but there was no statistically significant difference. Conclusion Serum HBV RNA levels are higher in the LLV patients compared to the MVR group and decline slowly. The decrease in HBV RNA levels after adjustment for NAs treatment is not significant compared to the maintained regimen group. It is suggested that combinations of other interventions are necessary to further reduce HBV transcriptional activity.

Key words: Low-level viremia, Maintained virological response, Hepatitis B virus RNA, Nucleoside/ nucleotide analogues, Hepatitis B e antigen

中图分类号:

R512.6+2

张域爽,吴娟丽,高涵,张毅恒,李涛,王磊. HBeAg阳性慢性乙型肝炎低病毒血症患者HBV RNA状态及干预后变化[J]. 山东大学学报 (医学版), 2025, 63(3): 85-91.

ZHANG Yushuang, WU Juanli, GAO Han, ZHANG Yiheng, LI Tao, WANG Lei. HBV RNA status and changes after intervention in HBeAg-positive chronic hepatitis B patients with low level viremia[J]. Journal of Shandong University (Health Sciences), 2025, 63(3): 85-91.

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