目的 探究经治慢性乙型肝炎低病毒血症患者序贯或联合富马酸丙酚替诺福韦的临床疗效及其影响因素.方法 选取2021年2月至2022年4月南京市第二医院诊治慢性乙型肝炎患者98例,根据治疗48周后血清HBV DNA水平,将患者分为低病毒血症组(n=37)和持续病毒学应答组(n=61).比较患者临床特征和治疗中血清病毒载量,对造成患者低病毒学症的潜在因素进行logistic回归分析.结果 低病毒血症组患者基线HBV DNA、HBsAg、HBeAg、AST以及接受 ETV 或 TDF 比例分别为 8.9(6.9,10.8)log10 IU/mL、4.4(3.6,4.9)log10 IU/mL、87.5(0.5,1214.9)log10 IU/mL、48.5(34.6,70.3)U/L 和 64.9％,显著高于持续病毒学应答组的 5.0(4.1,7.2)log,0 IU/mL、2.9(2.4,3.7)log10 IU/mL、0.4(0.1,3.8)log10 IU/mL、25.0(20.8,43.6)U/L 和 41.0％,年龄、BMI、ALT、接受 ALT 治疗比例以及接受 ETV 或 TDF联合 peg-IFNα-2b 治疗比例分别为(44.3±11.8)岁、(22.1±3.2)kg/m2、43.1(27.2,67.7)U/L、18.9％和 2.7％,显著低于持续病毒学应答组患者的(48.4±10.2)岁、(24.5±2.7)kg/m2、65.5(39.3,103.7)U/L、42.6％和16.4％,差异均有统计学意义(P＜0.05).低病毒血症组患者HBV DNA基线水平和治疗24周时水平分别为8.9(6.9,10.8)log10 IU/mL和4.9(3.8,5.9)％,显著高于持续病毒学应答组患者的5.0(4.1,7.2)log10 IU/mL和1.0(0.5,1.4)％,治疗24周时下降值和治疗24周时下降比例分别为2.2(1.5,3.0)log10 IU/mL和23.0(19.0,29.0)％,显著低于持续病毒学应答组患者的3.8(2.8,4.0)log10 IU/mL和74.0(60.0,82.0)％,差异均有统计学意义(P＜0.05).相关性分析可知,患者HBV DNA水平(r=0.386)、基线 HBsAg 水平(r=0.265)、基线 HBeAg 水平(r=0.152)、基线 AST 水平(r=0.164)以及接受 ETV 或TDF治疗(r=0.422)与低病毒血症呈显著正相关,患者年龄(r=-0.085)、BMI(r=-0.095)、治疗中HBV DNA下降比例(r=-0.753)、基线 ALT 水平(r=-0.155)、接受 TAF 治疗(r=-0.231)以及接受 ETV 或 TDF 联合 Peg-IFNα-2b 治疗(r=-0.184)与低病毒血症呈显著负相关.结论 血清病毒学水平是预后不佳的重要危险因素,转换用药或联合干扰素治疗可以在一定程度上预防低病毒血症的发生.
The clinical characteristics of chronic hepatitis B patients with low viremia post anti-viral therapy and the efficacies of different retreatment strategies
Objective To explore the influencing factors of previously treated chronic hepatitis B patients with low viremia,and to evaluate the efficacies of different re-treatment strategies.Methods A total of 98 patients with chronic hepatitis B were selected between February 2021 and April 2022.According to the serum HBV DNA load after 48 weeks of treatment,the patients were divided into a low viremia group(n=37)and a sustained virological response group(n=61).The clinical characteristics and the serum viral load of the two groups of patients during treatment were compared,and a correlation analysis on the potential factors that caused the patients'low virological symptoms were performed.Results By comparing the clinical characteristics,it was found that the baseline HBV DNA level,baseline HBsAg level,baseline HBeAg level,Aspartate aminotransferase(AST)level and the proportion of patients receiving entecavir(ETV)or tenofovir disoproxil fumarate(TDF)in the low viremia group were 8.9(6.9,10.8)(log10 IU/mL),4.4(3.6,4.9)(log10 IU/mL),87.5(0.5,1214.9)(log10 IU/mL),48.5(34.6,70.3)(U/L)and 64.9％,which were significantly higher than those of the sustained virological response group[5.0(4.1,7.2)(log10 IU/mL),2.9(2.4,3.7)(log10 IU/mL),0.4(0.1,3.8)(log10 IU/mL),25.0(20.8,43.6)(U/L)and 41.0％(P＜0.05)].The Age,BMI,ALT,proportion of receiving tenofovir alafenamide fumarate(TAF)treatment and the proportion of receiving ETV or TDF combined with peg-IFNα-2b treatment were(44.3±11.8),(22.1±3.2)kg/m2,43.1(27.2,67.7)(U/L),18.9％and 2.7％respectively,which were significantly lower than those of patients in sustained virological response group[(48.4±10.2),(24.5±2.7)kg/m2,65.5(39.3,103.7)(U/L),42.6％and 16.4％(P＜0.05)].Comparing the serum viral load after 24 weeks of treatment,it was shown that the baseline level of HBVDNA and the level at 24 weeks of treatment in the low viremia group were 8.9(6.9,10.8)(log10 IU/mL)and 4.9(3.8,5.9)(％)respectively,which were significantly higher than those of the sustained virological response group[5.0(4.1,7.2)(log10 IU/mL)and 1.0(0.5,1.4)(％)(P＜0.05)].The decline value at 24 weeks of treatment and the decline ratio at 24 weeks of treatment were 2.2(1.5,3.0)(log10 IU/mL)and 23.0(19.0,29.0)(％)respectively,which were significantly lower than those patients of the sustained virological response group[3.8(2.8,4.0)(log10 IU/mL)and 74.0(60.0,82.0)(％)].By correlation analysis,it was shown that HBV DNA level,baseline HBsAg level,baseline HBeAg level,baseline AST level of the patients receiving ETV or TDF treatment were significantly positively correlated with low virological symptoms.Age,HBV DNA decline rate during treatment,baseline ALT level,receiving TAF treatment,and receiving ETV or TDF combined with peg-IFNα-2b treatment were significantly negatively correlated with low viremia.Conclusion Serum virological level is an important risk factor for poor prognosis.Switching drugs to TAF sequentially or in combination with interferon therapy can prevent the occurrence of low viremia to a certain extent.
Chronic hepatitis BLow-level viremiaClinical features
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