血清HBV-LP联合HBV RNA对长效干扰素治疗慢性乙型肝炎停药后复发的预测价值

摘要/Abstract

摘要： 目的分析血清乙型肝炎病毒大蛋白(HBV-LP)联合乙型肝炎病毒核糖核酸(HBV RNA)对长效干扰素治疗慢性乙型肝炎(CHB)停药后复发的预测价值。方法选择2022年1月至2023年12月在我院接受长效干扰素治疗的70例CHB患者作为研究对象,并根据患者停药后复发情况分为复发组(n=19)、未复发组(n=51)。所有纳入患者于停药次日检测血清HBV-LP、HBV RNA。分析比较各组一般资料、相关生化指标及血清HBV-LP、HBV RNA,采用受试者工作特征(ROC)曲线评估血清HBV-LP联合HBV RNA对CHB患者停药后复发的预测价值;采用多因素logistic回归分析探讨影响CHB患者停药后复发的相关因素。结果复发组饮酒史占比高于未复发组(52.63%比21.57%),差异有统计学意义(P<0.05)。复发组血清ALT(89.55±23.42)U/L、AST(72.35±20.65)U/L、AFP(30.11±10.23)μg/L、HBsAg(8.10±1.67)lg IU/mL、HBcrAg(7.09±1.55)lg IU/mL、HBV DNA(4.24±0.88)lg IU/mL、HBV-LP(41.41±9.55)μg/L、HBV RNA(4.65±1.01)lg拷贝/mL,均高于未复发组[(31.34±10.55)U/L、(27.45±9.10)U/L、(21.52±6.56)μg/L、(5.10±1.09)lg IU/mL、(5.07±1.08)lg IU/mL、(2.11±0.43)lg IU/mL、(18.67±4.39)μg/L、(1.98±0.40)lg拷贝/mL],差异均有统计学意义(P<0.05)。ROC曲线分析显示,血清HBV-LP、HBV RNA及二者联合预测CHB患者停药后复发的AUC分别为0.840、0.852、0.901。多因素分析显示,ALT≥55.87 U/L(OR=2.421)、HBcrAg≥6.33 lg IU/mL(OR=2.787)、HBV DNA≥2.88 lg IU/mL(OR=1.900)、HBV-LP≥30.56 μg/L(OR=2.239)、HBV RNA≥3.09 lg拷贝/mL(OR=3.557)均为影响CHB患者停药后复发的危险因素(P<0.05)。结论血清HBV-LP、HBV RNA异常升高均与长效干扰素治疗CHB患者的停药后复发密切相关,均可有效预测患者停药后复发,且二者联合具有更高的预测价值。

关键词: 慢性乙型肝炎, 乙型肝炎病毒大蛋白, 乙型肝炎病毒核糖核酸, 复发, 预测价值

Abstract: Objective To analyze the predictive value of serum hepatitis B virus large protein (HBV-LP) combined with hepatitis B virus ribonucleic acid (HBV RNA) for recurrence after discontinuation of long-acting interferon in the treatment of chronic hepatitis B (CHB). Methods A total of 70 CHB patients who received long-acting interferon treatment in our hospital from January 2022 to December 2023 were selected and divided into the recurrence group (n=19) and the non-recurrence group (n=51) according to the recurrence situation after drug withdrawal. All included patients were tested for serum level of the HBV-LP and HBV RNA on the day after drug withdrawal. General data, related biochemical indicators, and the level of the HBV-LP and HBV RNA of each group were analyzed and compared. The predictive value of serum HBV-LP combined with HBV RNA for recurrence after drug withdrawal in CHB patients were evaluated by the receiver operator characteristics (ROC) curve. The related factors affecting recurrence after drug withdrawal in CHB patients were investigated by multivariate logistic regression analysis. Results The proportion of alcohol consumption history in the recurrence group was higher than that in the non-recurrence group (52.63% vs. 21.57%), and the difference was statistically significant (P<0.05). In the recurrence group, the serum ALT was (89.55±23.42) U/L, AST was (72.35±20.65) U/L, AFP was (30.11±10.23) μg/L, HBsAg was (8.10±1.67) lg IU/mL, and HBcrAg was (7.09±1.55) lg IU/mL, HBV DNA (4.24±0.88) lg IU/mL, HBV-LP (41.41±9.55) μg/L, HBV RNA (4.65±1.01) lg copies /mL, higher than the non-recurrence group [(31.34±10.55) U/L, (27.45±9.10) U/L, (21.52±6.56) μg/L, (5.10±1.09) lg IU/mL, (5.07±1.08) lg IU/mL, (2.11±0.43) lg IU/mL, (18.67±4.39) μg/L, (1.98±0.40) lg copies /mL], and the difference was statistically significant (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of serum HBV-LP, HBV RNA, and their combination for predicting recurrence after drug withdrawal in CHB patients were 0.840, 0.852, and 0.901, respectively. ALT≥55.87 U/L (OR=2.421), HBcrAg≥6.33 lg IU/mL (OR=2.787), HBV DNA≥2.88 lg IU/mL (OR=1.900), HBV-LP ≥ 30.56 μg/L (OR=2.239), and HBV RNA ≥ 3.09 lg copies/mL (OR=3.557) were all risk factors for recurrence after drug withdrawal in CHB patients (P<0.05). Conclusion Abnormal elevation of serum HBV-LP and HBV RNA are closely related to recurrence after drug withdrawal in CHB patients treated with long-acting interferon, and both can effectively predict recurrence after drug withdrawal. Moreover, their combination has a higher predictive value.

Key words: Chronic hepatitis B, Hepatitis B virus large protein, Hepatitis B virus ribonucleic acid, Recurrence, Predictive value

陈冲, 张敏敏. 血清HBV-LP联合HBV RNA对长效干扰素治疗慢性乙型肝炎停药后复发的预测价值[J]. 肝脏, 2025, 30(11): 1515-1520.

CHEN Chong, ZHANG Min-min. The predictive value of serum HBV-LP combined with HBV RNA for recurrence after discontinuation of long-acting interferon in the treatment of chronic hepatitis B[J]. Chinese Hepatolgy, 2025, 30(11): 1515-1520.

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