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长期恩替卡韦经治慢性乙型肝炎患者低病毒血症的相关影响因素

陈贺 傅涓涓 李丽 杨广德 潘修成

陈贺, 傅涓涓, 李丽, 等. 长期恩替卡韦经治慢性乙型肝炎患者低病毒血症的相关影响因素[J]. 临床肝胆病杂志, 2021, 37(3): 556-559. DOI: 10.3969/j.issn.1001-5256.2021.03.011
引用本文: 陈贺, 傅涓涓, 李丽, 等. 长期恩替卡韦经治慢性乙型肝炎患者低病毒血症的相关影响因素[J]. 临床肝胆病杂志, 2021, 37(3): 556-559. DOI: 10.3969/j.issn.1001-5256.2021.03.011
CHEN H, FU JJ, LI L, et al. Influencing factors for low-level viremia in chronic hepatitis B patients treated with long-term entecavir antiviral therapy[J]. J Clin Hepatol, 2021, 37(3): 556-559. DOI: 10.3969/j.issn.1001-5256.2021.03.011
Citation: CHEN H, FU JJ, LI L, et al. Influencing factors for low-level viremia in chronic hepatitis B patients treated with long-term entecavir antiviral therapy[J]. J Clin Hepatol, 2021, 37(3): 556-559. DOI: 10.3969/j.issn.1001-5256.2021.03.011

长期恩替卡韦经治慢性乙型肝炎患者低病毒血症的相关影响因素

DOI: 10.3969/j.issn.1001-5256.2021.03.011
基金项目: 

十三五艾滋病和病毒性肝炎等重大传染病防治项目 2018ZX10302206-001-003

详细信息
    作者简介:

    陈贺(1993—),男,主要从事病毒性肝炎诊治方面的研究

    通讯作者:

    潘修成,xzpxc68@126.com

  • 利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突,特此声明。
  • 作者贡献声明:陈贺负责课题设计,资料分析,拟定写作思路,撰写论文;傅涓涓、李丽、杨广德参与收集数据;潘修成指导撰写文章并最后定稿。
  • 中图分类号: R512.62

Influencing factors for low-level viremia in chronic hepatitis B patients treated with long-term entecavir antiviral therapy

  • 摘要:   目的  探讨长期接受恩替卡韦治疗的慢性乙型肝炎(CHB)患者仍维持低水平病毒复制的相关影响因素。  方法  选取2018年11月—2020年6月于徐州医科大学附属医院门诊接受恩替卡韦抗病毒治疗至少1年的CHB患者,根据至观察期结束患者HBV DNA载量分为低病毒血症(LLV)组和持续病毒学应答(SVR)组。观察患者人口学特征参数和实验室检测指标。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。采用多因素logistic回归分析长期恩替卡韦经治患者出现LLV的影响因素。  结果  共纳入560例CHB患者,其中LLV组204例,SVR组356例。两组患者比较,年龄(Z=-3.530,P<0.001)、性别(χ2=4.270,P=0.039)、是否存在肝硬化(χ2=53.879,P<0.001)、服药依从性(χ2=5.326,P=0.021)、HBeAg阳性率(χ2 =90.681,P<0.001)、治疗前基线HBV DNA载量(Z=-8.337,P<0.001)、基线HBsAg定量(Z=-10.472,P<0.001)以及用药类型(χ2=7.558,P=0.006)差异均有统计学意义。多因素logistic回归分析显示,治疗前基线HBeAg状态(OR=3.381,95%CI:1.985~5.756,P<0.001)、HBV DNA载量(OR=1.223,95%CI:1.050~1.424,P=0.010)和HBsAg定量(OR=2.448,95%CI:1.743~3.438,P<0.001)是长期恩替卡韦抗病毒治疗出现LLV的危险因素。  结论  在临床实践中,基线高载量HBV DNA水平、高HBsAg定量和HBeAg阳性的CHB患者即使长期坚持服用恩替卡韦抗病毒治疗,也存在较高的LLV风险。因此,对于此类人群应予以重视,需动态监测HBsAg定量、HBV DNA载量、HBeAg状态。
  • 表  1  纳入CHB患者基线资料

    指标 所有患者 (n=560) SVR组 (n=356) LLV组 (n=204) 统计值 P
    年龄(岁) 45(36~52) 47(37~53) 42(33~48) Z=-3.530 <0.001
    男性[例(%)] 399(71.3) 243(68.3) 156(76.5) χ2=4.270 0.039
    BMI(kg/m2) 23.95±3.37 23.87±3.39 24.10±3.35 t=-0.797 0.426
    肝硬化[例(%)] 231(41.3) 188(52.8) 43(21.1) χ2=53.879 <0.001
    家族史[例(%)] 213(38.0) 128(36.0) 85(41.7) χ2=1.795 0.180
    良好服药依从性[例(%)] 507(90.5) 330(92.7) 177(86.8) χ2=5.326 0.021
    糖尿病[例(%)] 28(5.0) 18(5.1) 10(4.9) χ2=0.006 0.936
    HBeAg阳性[例(%)] 350(62.5) 170(47.8) 180(88.2) χ2=90.681 <0.001
    HBV DNA(log10 IU/ml) 6.17(5.01~7.41) 5.75(4.39~6.97) 7.08(6.00~7.87) Z=-8.337 <0.001
    HBsAg(log10 IU/ml) 3.47(2.99~3.92) 3.21(2.76~3.69) 3.90(3.37~4.44) Z=-10.472 <0.001
    AST(U/L) 56.00(36.00~89.75) 56.00(35.00~92.50) 56.00(38.25~88.75) Z=-0.274 0.784
    ALT(U/L) 73.00(45.00~123.75) 68.50(43.00~128.85) 78.00(48.25~117.50) Z=-0.691 0.489
    用药类型[例(%)] χ2=7.558 0.006
      恩替卡韦初治 517(92.3) 337(94.7) 180(88.2)
      转换至恩替卡韦 43(7.7) 19(5.3) 24(11.8)
    下载: 导出CSV

    表  2  恩替卡韦经治CHB患者低病毒血症的多因素logistic回归分析

    变量 B SE Wald OR 95%CI P
    年龄 -0.001 0.010 0.003 0.999 0.981~1.019 0.957
    男性 0.376 0.236 2.527 1.456 0.916~2.314 0.112
    肝硬化 -0.469 0.250 3.503 0.626 0.383~1.022 0.061
    良好的依从性 -0.504 0.352 2.048 0.604 0.303~1.205 0.152
    HBeAg阳性 1.218 0.272 20.122 3.381 1.985~5.756 <0.001
    HBV DNA 0.201 0.078 6.719 1.223 1.050~1.424 0.010
    HBsAg 0.895 0.173 26.695 2.448 1.743~3.438 <0.001
    用药类型 0.390 0.379 1.061 1.478 0.703~3.107 0.303
    下载: 导出CSV
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  • 收稿日期:  2020-09-12
  • 修回日期:  2020-10-06
  • 刊出日期:  2021-03-16
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