抗病毒治疗学龄前HBeAg阴性慢性乙型肝炎患儿的HBsAg清除率及其影响因素

肝脏 ›› 2022, Vol. 27 ›› Issue (7): 756-758.

抗病毒治疗学龄前HBeAg阴性慢性乙型肝炎患儿的HBsAg清除率及其影响因素

张丰晓, 张家伟, 白雪松, 胡春霞, 曾艳丽

466000 河南周口市中心医院感染科(张丰晓,张家伟,白雪松,胡春霞);河南省人民医院感染性疾病科(曾艳丽)

收稿日期:2021-06-30 出版日期:2022-07-31 发布日期:2022-08-25
基金资助:
二〇一九年度河南省卫生健康科技英才海外研修工程(HWYX2019137)

HBsAg clearance rate and its influence factors in preschool children with HBeAg negative chronic hepatitis B treated with antiviral therapy

ZHANG Feng-xiao¹, ZHANG Jia-wei¹, BAI Xue-song¹, HU Chun-xia¹, ZENG Yan-li²

1. Department of Infection, Zhoukou Central Hospital, Henan 466000, China;
2. Department of Infectious Diseases, Henan Province People’s Hospital, Henan Provincial Key Laboratory of Hepatology, Zhengzhou People’s Hospital of Zhengzhou University, Henan 450003, China

Received:2021-06-30 Online:2022-07-31 Published:2022-08-25

摘要/Abstract

摘要： 目的观察抗病毒治疗学龄前HBeAg阴性慢性乙型肝炎患儿的HBsAg清除率,并分析其影响因素。方法纳入周口市中心医院收治的HBeAg阴性慢性乙型肝炎患儿68例,患儿均经抗病毒治疗,随访观察患儿HBsAg清除情况,并收集患儿一般资料及血清丙氨酸转氨酶(ALT)、HBV DNA、HBsAg基线及治疗后变化水平,分析抗病毒治疗学龄前HBeAg阴性慢性乙型肝炎患儿的HBsAg清除率的影响因素。结果 68例患儿中,HBsAg清除20例(29.41%),48例(70.59%)患儿HBsAg未清除。清除组年龄为(2.9±0.6)岁、基线HBV DNA为(9.89±2.54)×10⁶U/mL、基线HBsAg水平为(2.62±0.50)lgIU/mL,均低于未清除组(4.8±0.5)岁、(11.23±2.10)×10⁶U/mL、(2.98±0.42)lgIU/mL(P<0.05)。治疗第24周HBsAg下降水平为(1.60±0.41)lgIU/mL高于未清除组的(0.84±0.28)lgIU/mL(P<0.05)。多因素logistic回归性分析显示,年龄(OR=1.520,95%CI=1.140～2.027)、基线HBV DNA(OR=1.480,95%CI=1.140～1.921)、基线HBsAg(OR=1.654,95%CI=1.370～1.997)、治疗第24周HBsAg下降水平(OR=1.286,95%CI=1.021～1.620)是学龄前HBeAg阴性慢性乙型肝炎患儿HBsAg清除率的独立影响因素(P<0.05)。结论部分学龄前HBeAg阴性慢性乙型肝炎患儿可通过抗病毒治疗获得HBsAg清除,年龄、基线HBV DNA、基线HBsAg、治疗第24周HBsAg下降水平是影响患儿HBsAg清除率的独立影响因素。

关键词: 慢性乙型肝炎, 抗病毒, 学龄前儿童, 乙型肝炎e抗原, 乙型肝炎表面抗原, 清除率

Abstract: Objective To investigate the clearance rate of hepatitis B surface antigen (HBsAg) in preschool children with hepatitis B e antigen (HBeAg) negative chronic hepatitis B (CHB) treated with antiviral therapy and to analyze the influence factors.Methods Sixty-eight patients with HBeAg negative CHB treated in our hospital were enrolled. All the children received antiviral therapy. The clinical data of HBsAg clearance rate was collected. The general data including serum alanine transaminase (ALT) level, hepatitis B virus (HBV) DNA level, HBsAg level (at baseline and after treatment) were collected. Influencing factors of HBsAg clearance rate were analyzed.Results Twenty children (29.41%) with HBsAg clearance were selected into clearance group and 48 cases (70.59%) without HBsAg clearance were selected into non-clearance group. The average age[(2.86 ± 0.62) years], baseline HBV DNA level [(9.89±2.54) × 10⁶ U/mL] and baseline HBsAg level [(2.62 ± 0.50) lgIU/mL] of the clearance group were significantly lower than those of the non clearance group[(4.84 ± 0.54) years, (11.23 ± 2.10) × 10⁶U/mL, (2.98 ± 0.42) lgIU/ml (P<0.05)], and the decrease level of HBsAg at the 24th week of treatment [(1.60 ± 0.41) lgIU/ml] was significantly higher than that of the non clearance group[(0.84 ± 0.28) lgIU/ml (P<0.05)]. Multivariate logistic regression analysis showed that age (OR=1.520, 95%CI=1.140~2.027), baseline HBV DNA level (OR=1.480,95%CI=1.140 ~ 1.921), baseline HBsAg level (OR=1.654, 95%CI=1.370 ~ 1.997), decreased level of HBsAg at the 24th week of treatment (OR=1.286, 95%CI=1.021 ~ 1.620) were independent influencing factors of HBsAg clearance rate in preschool children with HBeAg negative CHB (P<0.05).Conclusion HBsAg clearance may occur in some preschool children with HBeAg negative CHB after antiviral therapy. Age, baseline HBV DNA level, baseline HBsAg level and the decrease level of HBsAg at the 24th week of treatment are the independent influencing factors of HBsAg clearance rate.

Key words: Hepatitis B, Antiviral, Preschool children, Hepatitis B e antigen, Hepatitis B surface antigen, Clearance rate

张丰晓, 张家伟, 白雪松, 胡春霞, 曾艳丽. 抗病毒治疗学龄前HBeAg阴性慢性乙型肝炎患儿的HBsAg清除率及其影响因素[J]. 肝脏, 2022, 27(7): 756-758.

ZHANG Feng-xiao, ZHANG Jia-wei, BAI Xue-song, HU Chun-xia, ZENG Yan-li. HBsAg clearance rate and its influence factors in preschool children with HBeAg negative chronic hepatitis B treated with antiviral therapy[J]. Chinese Hepatolgy, 2022, 27(7): 756-758.

参考文献

[1] Mak LY, Seto WK, Fung J, et al. New Biomarkers of chronic hepatitis B. Gut Liver, 2019 ,13(6):589-595.
[2] 刘如玉, 李明慧, 谢尧,等. HBeAg阴性初治慢乙肝患者恩替卡韦4年抗病毒治疗FIB-4评分动态变化研究. 中华实验和临床病毒学杂志, 2020, 34(1):51-56.
[3] 周莹, 杨俊梅, 张桂珍,等. 学龄前HBeAg阴性慢性乙型肝炎患儿临床特点分析. 肝脏, 2020,25(6):605-607.
[4] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年更新版). 临床肝胆病杂志 2015,31(12):1941-1960.
[5] 金蕾, 李旭, 叶珺, 等. FIB-4对HBeAg阴性慢性HBV感染者抗病毒治疗指征中肝脏炎症和纤维化的判断价值. 安徽医科大学学报, 2020, 55(6):146-150.
[6] 翁艳, 刘晓川, 贾志伟,等. HBeAg阴性与阳性慢性乙肝合并肝硬化患者血清HBV DNA载量与肝脏生化指标的相关性. 海南医学, 2019, 30(4):18-21.
[7] 邓德丽, 江建宁, 苏明华,等. HBeAg阴性低病毒载量慢性乙型肝炎患者的肝组织学状态与转归. 中华肝脏病杂志, 2020, 28(12):1013-1017.
[8] Lee TY, Hsu YC, Tseng HC, et al. Association of daily aspirin therapy with risk of hepatocellular carcinoma in patients with chronic hepatitis B. JAMA Intern Med, 2019,179(5):633-640.
[9] 朱世殊, 董漪, 王丽旻, 等. 1～7岁儿童E抗原阴性慢性乙型病毒性肝炎肝脏病理特征及抗病毒治疗效果. 中华儿科杂志, 2016, 54(8):587-591.
[10] Ning Q, Wu D, Wang GQ, et al. Roadmap to functional cure of chronic hepatitis B: an expert consensus.J Viral Hepat, 2019 ,26(10):1146-1155.
[11] 唐平阳, 王洁冰, 张晓兰, 等. 血清HBeAg阴性慢性乙型肝炎患者APRI,FIB-4和血清TGF-β1水平变化. 实用肝脏病杂志, 2020, 23(6):47-50.
[12] 郭强, 赵科孝. HBeAg阴性慢性乙肝合并肝硬化患者血清HBV-DNA水平与肝功能的相关性. 海南医学, 2019, 30(8):973-976.
[13] Carey I, Gersch J, Wang B, et al. Pregenomic HBV RNA and hepatitis B core-related antigen predict outcomes in hepatitis B e Antigen-negative chronic hepatitis B patients suppressed on nucleos(T)ide analogue therapy. Hepatology, 2020,72(1):42-57.
[14] 孟方园, 高沿航. 与HBeAg阴性慢性乙型肝炎患者成功停药相关的病毒和免疫因素. 临床肝胆病杂志 2021,37(2):395-397.
[15] 闫一杰, 王晓晓, 曹振环, 等. 48周HBsAg低水平的HBeAg阴性慢性乙型肝炎患者是获得HBsAg清除的优势人群. 中华肝脏病杂志, 2018, 26(11):813-818.