接受核苷(酸)类似物抗病毒的慢性乙型肝炎患者发生低病毒血症危险因素分析*

doi:10.3969/j.issn.1672-5069.2024.03.005

摘要/Abstract

摘要： 目的探讨接受核苷(酸)类似物(NAs)抗病毒治疗的慢性乙型肝炎(CHB)患者发生低病毒血症(LLV)的危险因素。方法 2021年1月～2022年12月我院诊治的CHB患者98例,其中25例接受富马酸丙酚替诺福韦片(TAF)、43例接受恩替卡韦片(ETV)和30例接受替诺福韦二吡呋酯(TDF)治疗。纳入患者至少完成24周抗病毒治疗。采用Taqman实时荧光定量PCR法检测血清HBV DNA载量,使用HISCL-5000高敏化学发光免疫分析仪检测血清HBsAg和HBeAg水平。应用多因素Logistic回归分析影响LLV发生的危险因素。结果在治疗24周末,发现LLV者43例(43.9%),VR者55例(56.1%);LLV组应用ETV治疗、乙型肝炎家族史、合并脂肪肝占比、血清HBsAg和HBV DNA水平分别为60.4%、60.5%、55.8%、(4.6±0.9)lg IU/mL和(7.2±1.2)lg IU/mL,显著高于VR组【分别为30.9%、40.0%、43.6%、(3.5±0.7)lg IU/mL和(5.7±1.8)lg IU/mL,P<0.05】;在治疗12周和24周末,LLV组血清HBV DNA载量分别为(5.3±1.4)lg IU/mL和(0.5±0.3)lg IU/mL,显著高于VR组【分别为(3.4±1.1)lg IU/mL和(0.0±0.0)lg IU/mL,P<0.05】; 经多因素Logistic回归分析,结果发现乙型肝炎家族史、合并脂肪肝、基线血清HBV DNA载量和治疗过程中病毒学应答反应速度均是影响LLV发生的独立危险因素(P<0.05)。结论部分CHB患者在接受NAs治疗过程中可能会发生LLV,了解这些容易导致LLV发生的危险因素并给予及时的监测和处理,可能对提高抗病毒疗效有帮助。

关键词: 慢性乙型肝炎, 核苷(酸)类似物, 低病毒血症, HBV DNA, 治疗

Abstract: Objective The aim of this study was to investigate the phenomena of low level viremia (LLV) in patients with chronic hepatitis B (CHB) receiving nucleos(t)ide analogue (NAs) treatment. Methods A retrospective study on 98 patients with CHB admitted to our hospital between January 2021 and December 2022 were performed, the tenofovir alafenamide fumarate (TAF) were given in 25 cases, the entecavir (ETV) in 43 cases and tenofovir disoproxil fumarate (TDF) in 30 cases. All enrolled patients got the antiviral treatment for at least 24 weeks. Serum HBV DNA loads were assayed by Taqman real-time quantitative PCR, and serum HBsAg and HBeAg levels were detected by highly sensitive chemiluminescence Immunoassay. The risk factors were evaluated by multivariate Logistic regression analysis. Results At the end of 24 week treatment, the LLV was found in 43 patients (43.9%) and the virological response (VR) was found in 55 patients(56.1%); the percentages of baseline ETV administration, hepatitis B family history, concomitant fatty liver, and serum HBsAg level and HBV DNA load in patients with LLV were 60.4%, 60.5%, 55.8%, (4.6±0.9)lg IU/mL and (7.2±1.2)lg IU/mL, all significantly higher than [30.9%, 40.0%, 43.6%, (3.5±0.7)lg IU/mL and (5.7±1.8)lg IU/mL, P<0.05] in patients with VR; at the end of 12 week and 24 week treatment, serum HBV DNA loads in patients with LLV were (5.3±1.4)lg IU/mL and (0.5±0.3)lg IU/mL, both significantly higher than [(3.4±1.1)lg IU/mL and (0.0±0.0)lg IU/mL, P<0.05] in patients with VR; the multivariate Logistic regression analysis showed that the hepatitis B family history, concomitant fatty liver, baseline serum HBV DNA loads and the virological response speed were all the independent risk factors for the occurrence of LLV in patients with CHB undergoing NAs antiviral treatment(P<0.05). Conclusion Almost half of patients with CHB could not obtain complete VR during NAs antiviral treatment as serum HBV DNA loads were monitored by highly sensitive Taqman real-time quantitative PCR, the clinicians should take the risk factors leading to LLV into consideration, and deal appropriately with it.

Key words: Hepatitis B, Nucleos(t)ide analogues, Low level viremia, HBV DNA, Therapy

周安琪, 孟舒婷, 吴应冬, 张弦. 接受核苷(酸)类似物抗病毒的慢性乙型肝炎患者发生低病毒血症危险因素分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 337-340.

Zhou Anqi, Meng Shuting, Wu Yingdong, et al. Low level viremia in patients with chronic hepatitis B receiving nucleos(t)ide analogue treatment[J]. Journal of Practical Hepatology, 2024, 27(3): 337-340.

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接受核苷(酸)类似物抗病毒的慢性乙型肝炎患者发生低病毒血症危险因素分析^*

Low level viremia in patients with chronic hepatitis B receiving nucleos(t)ide analogue treatment

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