血清HBsAg和HBeAg定量检测评估恩替卡韦治疗乙型肝炎肝硬化合并原发性肝癌患者病毒应答的临床价值

doi:10.3969/j.issn.1006-5725.2023.17.016

Abstract

Abstract:

Objective To explore the clinical value of quantitative detection of hepatitis B surface antigen （HBsAg） and hepatitis B virus E antigen （HBeAg） serum levels to evaluate the viral response （HBV?DNA） of entecavir in patients with hepatitis B cirrhosis complicated with primary liver cancer. Methods From April 2020 to July 2021， 80 patients with moderate liver cirrhosis complicated with primary liver cancer were treated in our hospital. According to whether virological response occurred at the 8th week of treatment， the patients were divided into response group （n = 47） and non?response group （n = 33）. The correlations between serum HBsAg， HBeAg and HBV?DNA levels were compared before and after treatment. The value of serum HBsAg and HBeAg levels in predicting viral response was determined by receiver operating characteristic （ROC） curve. The 1?year survival rate was analyzed by Kaplan?Meier method. Results The serum levels of HBsAg and HBeAg were positively correlated with the level of HBV?DNA before treatment. There were significant differences in serum HBsAg and HBeAg levels at 8 weeks， 12 weeks， 24 weeks， 36 weeks and 48 weeks after treatment. At the 48th week of treatment， the maximum area under the ROC curve of viral response predicted by serum HBsAg level was 0.818 （95% CI：0.709 ~ 0.965）. The best cut?off point was （40.63 ± 10.28） ng/mL. The sensitivity is 91.34%. The specificity is 71.93%. At the 8th week of treatment， the area under the ROC curve predicted by serum HBeAg level was up to 0.801 （95% CI：0.673 ~ 0.979）. The best cut?off point was （53.38 ± 9.86） NCU/mL. The sensitivity is 88.52% and the specificity is 83.42%. The results of survival analysis showed that the 1?year survival rate of the response group was 87.31% higher than that of the non?response group 62.18%， and the difference was statistically significant （P < 0.05）. Conclusion Serum HBsAg and HBeAg levels were correlated with viral response in patients with hepatitis B cirrhosis complicated with primary liver cancer treated with entecavir. Quantitative detection of serum HBsAg and HBeAg levels to evaluate the viral response of patients has high clinical value.

Key words: hepatitis B cirrhosis, primary liver cancer, hepatitis B surface antigen, hepatitis B e antigen, viral response

CLC Number:

R735.7

Xinyi ZHANG,Guoliang ZHANG,Guanglin. ZHANG. Clinical value of quantitative detection of serum HBsAg and HBeAg to evaluate the viral response of entecavir in patients with hepatitis B cirrhosis complicated with primary liver cancer[J]. The Journal of Practical Medicine, 2023, 39(17): 2241-2247.

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References 23

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评分	脾脏厚度（cm）	血小板计数（× 10⁹/L）	食管胃底静脉曲张	门静脉宽度（mm）
0分	< 4.0	> 100	无	< 12
1分	4.0 ~ 5.0	70 ~ 100	轻度	12 ~ 14
2分	> 5.0	< 70	中重度	> 14

项目	VR（n = 47）	NVR（n = 33）	χ ²/t	P值
年龄（岁）	37.16 ± 8.36	36.07 ± 8.42	0.572	0.569
男性［例（%）］	26（55.32）	20（60.61）	0.222	0.638
BMI（kg/m²）	22.38 ± 4.03	21.97 ± 4.39	0.432	0.667
病程（年）	6.54 ± 1.46	6.35 ± 1.71	0.534	0.595
高血压症［例（%）］	22（46.81）	17（51.52）	0.172	0.678
糖尿病［例（%）］	14（29.79）	9（27.27）	0.060	0.807
吸烟史［例（%）］	18（38.30）	13（39.39）	0.010	0.921
肝癌遗传史［例（%）］	17（36.17）	11（33.33）	0.069	0.793

HBV-DNA log值	例数	HBsAg（ng/mL）	HBeAg（NCU/mL）
≤ 6 copies/mL	14	35.85 ± 9.36	9.83 ± 1.62
> 6且≤ 8 copies/mL	58	70.15 ± 16.87	27.49 ± 8.25
> 8 copies/mL	8	136.07 ± 22.91	43.28 ± 13.51
t值		7.421	3.495
P值		0.007	0.016

指标	组别	例数	8周	12周	24周	36周	48周
HBsAg（ng/mL）	VR	47	118.71 ± 20.45	93.36 ± 14.78	78.48 ± 11.32	51.97 ± 16.31	31.57 ± 9.25
	NVR	33	141.27 ± 31.75	107.65 ± 24.82	95.31 ± 13.62	82.70 ± 19.92	43.94 ± 12.68
	t值		3.866	3.221	6.017	7.568	5.048
	P值		0.000	0.002	0.000	0.000	0.000
HBeAg（NCU/mL）	VR	47	50.96 ± 9.21	36.54 ± 10.29	20.25 ± 8.02	13.23 ± 3.12	7.28 ± 1.53
	NVR	33	56.18 ± 11.06	48.13 ± 13.46	34.29 ± 9.13	26.25 ± 8.27	11.32 ± 2.41
	t值		2.296	4.364	7.279	9.861	9.170
	P值		0.024	0.000	0.000	0.000	0.000

血清指标	治疗时间	AUC	最佳截断值（x ± s）	灵敏度（%）	特异度（%）	P值	95%CI
HBsAg（ng/mL）	8周	0.795	132.49 ± 21.47	95.17	72.65	0.003	0.635 ~ 0.962
	12周	0.706	105.70 ± 14.26	79.02	58.62	0.015	0.627 ~ 0.859
	24周	0.817	93.24 ± 12.15	94.28	77.04	0.006	0.707 ~ 0.921
	36周	0.718	76.15 ± 18.93	88.62	58.53	0.012	0.627 ~ 0.862
	48周	0.818	40.63 ± 10.28	91.34	71.93	0.008	0.709 ~ 0.965
HBeAg（NCU/mL）	8周	0.801	53.38 ± 9.86	88.52	83.42	0.007	0.673 ~ 0.979
	12周	0.800	47.25 ± 9.74	91.65	72.65	0.005	0.711 ~ 0.918
	24周	0.721	31.57 ± 8.03	95.17	77.65	0.011	0.616 ~ 0.895
	36周	0.754	24.16 ± 7.25	91.02	61.93	0.009	0.685 ~ 0.947
	48周	0.701	9.24 ± 2.79	94.28	68.04	0.016	0.656 ~ 0.853

Clinical value of quantitative detection of serum HBsAg and HBeAg to evaluate the viral response of entecavir in patients with hepatitis B cirrhosis complicated with primary liver cancer

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