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基线HBV DNA水平对代偿期乙型肝炎肝硬化患者抗病毒治疗后临床转归的影响
文章发布日期:2018年07月06日  来源:  作者:吴晓宁,张伟,周家玲,等  点击次数:437次  下载次数:104次

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【摘要】:目的分析基线HBV DNA水平对代偿期乙型肝炎肝硬化患者抗病毒治疗后临床转归的影响。方法选取首都医科大学附属北京友谊医院肝病中心2005年-2015年代偿期乙型肝炎肝硬化患者106例,给予核苷和核苷酸类药物抗病毒治疗,对患者进行前瞻性随访观察3年。按治疗前HBV DNA水平将患者分为3组,即HBV DNA<105 IU/ml组、105~107 IU/ml组和>107 IU/ml组。比较3组患者基线特征、抗病毒治疗疗效及肝脏相关终点事件(LREs)发生率。组间比较采用重复测量资料的方差分析或Friedman Test检验;计数资料组间比较采用χ2检验。采用Kaplan-Meier 法计算LREs发生率并绘制生存曲线,各组之间的比较采用log-rank对数秩检验。结果3组患者在年龄、性别、HBeAg、生化指标、肝脏硬度及CTP评分上差异均无统计学意义(P值均>0.05)。HBV DNA水平随时间的变化趋势差异有统计学意义(F=8.35,P<0.05);3组间比较HBV DNA水平的变化差异也有统计学意义(F=13.95,P<0.05)。3组患者在治疗6个月时HBV DNA水平较基线都显著下降,其中HBV DNA<105 IU/ml组和105~107IU/ml组患者实现中位HBV DNA低于检测限,而HBV DNA>107 IU/ml组在治疗12个月后实现中位HBV DNA低于检测限。在治疗12个月及24个月时,3组HBV DNA阴转率差异无统计学意义(χ2值分别为5.97、684,P值均>0.05),在治疗36个月时,3组HBV DNA阴转率分别为95.7%、88.0%和77.8%,差异有统计学意义(χ2=12.75,P<0.05)。3组LREs发生率差异无统计学意义(P>0.05)。结论乙型肝炎肝硬化患者抗病毒治疗后HBV DNA水平显著下降,高水平复制的患者病毒学应答速度较慢,但基线HBV DNA水平对抗病毒治疗后3年内LREs的发生率无显著影响。
【Abstract】:ObjectiveTo investigate the influence of baseline HBV DNA level on the clinical outcome of patients with compensated hepatitis B cirrhosis after antiviral therapy. MethodsA total of 106 patients with compensated hepatitis B cirrhosis who were treated in Liver Research Center, Beijing Friendship Hospital, Capital Medical University from 2005 to 2015 were enrolled and were given antiviral therapy with nucleos(t)ide analogues. A three-year prospective follow-up was performed for all patients. According to the baseline HBV DNA level, the patients were divided into HBV DNA <105 IU/ml group, 105-107 IU/ml group, and >107 IU/ml group. The three groups were compared in terms of baseline characteristics, outcome of antiviral therapy, and incidence rate of liver-related events (LREs). A repeated-measures analysis of variance or the Friedman rank sum test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to calculate the incidence rates of LREs and plot survival curves, and the log-rank test was used for comparison between groups. ResultsThere were no significant differences between the three groups in age, sex, HBeAg, biochemical parameters, liver stiffness, and Child-Turcotte-Pugh score (all P>005). There were significant differences between the three groups in the change trend of HBV DNA level (F=835, P<0.05) and the degree of such change (F=13.95, P<0.05). At 6 months of treatment, all three groups had a significant reduction in HBV DNA level, and the HBV DNA <105 IU/ml group and the 105-107 IU/ml group achieved a median HBV DNA level of below the limit of detection, while the HBV DNA >107 IU/ml group achieved such a level at 12 months of treatment. At 12 and 24 months of treatment, there was no significant difference in HBV DNA clearance rate between the three groups (χ2=5.97 and 6.84, both P>0.05); at 36 months of treatment, there was a significant difference in HBV DNA clearance rate between the three groups (95.7% vs 88.0% vs 77.8%, χ2=12.75, P<0.05). There was no significant difference in the incidence rate of LREs between the three groups (P>0.05). ConclusionPatients with compensated hepatitis B cirrhosis have a significant reduction in HBV DNA level after antiviral therapy. Although patients with a high level of replication have slow virologic response, baseline HBV DNA level has no influence on the incidence rate of LREs within 3 years of antiviral therapy.
【关键字】:肝硬化; 肝炎, 乙型, 慢性; HBV DNA; 抗病毒治疗
【Key words】:liver cirrhosis; hepatitis B, chronic; HBV DNA; antiviral therapy
【引证本文】:WU XN, ZHANG W, ZHOU JL, et al. Influence of baseline HBV DNA level on the clinical outcome of patients with compensated hepatitis B cirrhosis after antiviral therapy[J]. J Clin Hepatol, 2018, 34(8): 1678-1682. (in Chinese)
吴晓宁, 张伟, 周家玲, 等. 基线HBV DNA水平对代偿期乙型肝炎肝硬化患者抗病毒治疗后临床转归的影响[J]. 临床肝胆病杂志, 2018, 34(8): 1678-1682.

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