血清HBV RNA对ALT正常慢性乙型肝炎患者HBeAg血清学转换的预测作用

肝脏 ›› 2026, Vol. 31 ›› Issue (5): 631-634.

血清HBV RNA对ALT正常慢性乙型肝炎患者HBeAg血清学转换的预测作用

金业森, 杨广越, 陶乐, 吴柳, 叶军, 马文婷

200062 上海上海中医药大学附属普陀医院(金业森,杨广越);
200062 上海上海中医药大学附属普陀医院感染科(陶乐,吴柳,叶军,马文婷)

收稿日期:2025-08-30 发布日期:2026-07-10
通讯作者: 马文婷,Email:mwt321@163.com
基金资助:
上海市卫生健康委员会卫生行业临床研究专项(202040149)

Using serum HBV RNA measurement to predict HBeAg seroconversion in chronic hepatitis B patients with normal alanine aminotransferase levels

JIN Ye-sen¹, YANG Guang-yue¹, TAO Le², WU Liu², YE Jun² , MA Wen-ting²

1. Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China;
2. Department of Infectious Diseases, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China

Received:2025-08-30 Published:2026-07-10
Contact: MA Wen-ting, Email: mwt321@163.com

摘要/Abstract

摘要： 目的探讨血清乙型肝炎病毒(hepatitis B virus, HBV)RNA 在预测正常丙氨酸氨基转移酶(alanine aminotransferase, ALT)慢性乙型肝炎(chronic hepatitis B , CHB)初治患者乙型肝炎e抗原(hepatitis B e antigen, HBeAg)血清学转换的预测价值。方法选取2017年1月至2021年6月在上海市普陀区中心医院收治的28例ALT正常的CHB初治患者,收集临床资料,采用PCR荧光探针法测定血清中HBV RNA的含量;予核苷(酸)类似物(nucleoside analogs, NAs)治疗。治疗96周后,将患者分为 HBeAg 血清学转换组和 HBeAg血清学未转换组,通过回归分析方法探讨HBeAg血清学转化的预测因素,受试者工作特征(receiver operating characteristic curve, ROC) 曲线分析血清HBV RNA对HBeAg血清转换的预测作用。结果共有28例CHB患者被纳入,均接受恩替卡韦、富马酸替诺福韦二吡呋酯治疗。治疗96周后,7例(25%)CHB患者获得HBeAg血清学转换。HBeAg血清转换组中,HBV DNA水平为(5.91±2.30)lg IU/mL、HBV RNA水平为(5.49±2.19)lg拷贝/mL,均低于非HBeAg血清转换组患者中的(7.50±1.37)lg IU/mL和(7.10±1.35)lg拷贝/mL,差异有统计学意义(P<0.05)。Logistic回归分析显示,基线HBV RNA水平(OR=0.521,95%CI:0.281～0.967,P=0.039)和肝纤维化分期(OR=3.584,95%CI:1.291～9.953,P=0.014)与HBeAg血清学转换密切相关。基线HBV RNA的ROC曲线下面积是0.782,最佳截断值为7.14 lg IU/mL,灵敏度为66.6%,特异度为85.7%。结论血清HBV RNA可能是预测ALT正常的HBeAg阳性CHB患者抗病毒治疗的良好途径。

关键词: 慢性乙型肝炎, HBeAg 血清学转换, HBV RNA

Abstract: Objective To investigate the predictive value of serum hepatitis B virus (HBV) RNA in predicting the HBeAg seroconversion in chronic hepatitis B patients with normal alanine aminotransferase (ALT) levels. Methods A total of 28 treatment-na?ve CHB patients with normal ALT levels admitted to the Putuo District Central Hospital in Shanghai between January 2017 and June 2021 were enrolled in this study. The clinical data of all patients were collected, and serum hepatitis B virus (HBV) RNA levels were measured using PCR fluorescence probe assays. All patients received nucleos(t)ide analog (NAs) therapy for 96 weeks and were then divided into an HBeAg seroconversion group and a non-seroconversion group. Regression analysis was used to explore the predictive factors associated with HBeAg seroconversion, and the receiver operating characteristic (ROC) curve was employed to evaluate the predictive performance. Results Twenty-eight CHB patients were included and treated with entecavir or tenofovir disoproxil fumarate. After 96 weeks of follow-up, 7 patients (25%) achieved HBeAg seroconversion. The HBeAg seroconversion group had significantly lower baseline HBV DNA levels (5.91±2.30 lg IU/mL) and HBV RNA levels (5.49±2.19 lg copies/mL) compared to those of the non-seroconversion group (7.50±1.37 lg IU/mL and 7.10±1.35 lg copies/mL, respectively), with statistical significance (P<0.05). Logistic regression analysis revealed that baseline HBV RNA levels (OR=0.521, 95%CI: 0.281~0.967, P=0.039) and liver fibrosis stage (OR=3.584, 95%CI: 1.291~9.953, P=0.014) were associated with HBeAg seroconversion. The area under the ROC curve (AUC) for baseline HBV RNA was 0.782, with an optimal cutoff value of 7.14 lg IU/mL, yielding a sensitivity of 66.6% and specificity of 85.7%. Conclusion Serum HBV RNA may serve as a valuable predictor for HBeAg seroconversion in HBeAg-positive CHB patients with normal ALT levels undergoing antiviral therapy.

Key words: Chronic viral hepatitis B, HBeAg serologic conversion, HBV RNA

金业森, 杨广越, 陶乐, 吴柳, 叶军, 马文婷. 血清HBV RNA对ALT正常慢性乙型肝炎患者HBeAg血清学转换的预测作用[J]. 肝脏, 2026, 31(5): 631-634.

JIN Ye-sen, YANG Guang-yue, TAO Le, WU Liu, YE Jun , MA Wen-ting. Using serum HBV RNA measurement to predict HBeAg seroconversion in chronic hepatitis B patients with normal alanine aminotransferase levels[J]. Chinese Hepatolgy, 2026, 31(5): 631-634.

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