高灵敏HBV DNA检测和ALT对低病毒载量肝硬化患者精准抗病毒治疗的评估价值

林燕; 张月荣; 王慧; 张耀弟; 吴丽阳; 魏世芳; 李象霖; 马艳云; 王春霞

doi:10.3969/j.issn.1001-5256.2020.11.010

高灵敏HBV DNA检测和ALT对低病毒载量肝硬化患者精准抗病毒治疗的评估价值

DOI: 10.3969/j.issn.1001-5256.2020.11.010

1. 兰州市第一人民医院感染科
2. 兰州市第一人民医院检验科

基金项目:

兰州市创新创业项目（2015-RC-73）；

详细信息

中图分类号: R512.62;R575.2
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出版历程
- 收稿日期: 2020-03-30
- 出版日期: 2020-11-20

Value of highly sensitive nucleic acid detection and aminotransferase level in evaluating precise antiviral therapy for liver cirrhosis patients with a low viral load

Department of Infectious Diseases,The First People's Hospital of Lanzhou
Department of Clinical Laboratory,The First People's Hospital of Lanzhou

Research funding:

摘要

摘要:
目的探讨高灵敏核酸检测对肝硬化精准抗病毒治疗的临床意义及与转氨酶水平的关系。方法选取2013年5月-2019年4月兰州市第一人民医院住院和门诊的乙型肝炎肝硬化患者377例,分别行国产HBV DNA和高灵敏Cobas HBV DNA检测。所有患者进行生化、凝血四项、血常规、上腹部CT或超声检查,观察不同HBV DNA检测试剂对低病毒载量肝硬化患者检测的敏感度,ALT水平与病毒载量的相关性。计量资料两组间治疗前后比较采用配对t检验。采用受试者工作特征曲线（ROC曲线）筛选ALT在不同HBV DNA界值的最佳预测值。结果 377例乙型肝炎肝硬化患者经国产HBV DNA检测阳性215例,阴性162例。HBV DNA阴性162例患者再经Cobas HBV DNA检测发现104例阳性（64.2%）,平均（267.5±42.3） IU/ml。104例乙型肝炎肝硬化患者经24周抗病毒治疗后病毒复制水平、ALT、肝功能Child-Pugh评分等指标明显改善,HBV DNA由治疗前（267.5±32.2） IU/ml下降至（59.6±7.7） IU/ml（t=3.486,P=0.002）,ALT由治疗前（...
- HBV DNA /
- 丙氨酸转氨酶 /
- 肝硬化 /
- 抗病毒治疗
Abstract:
Objective To investigate the clinical significance of highly sensitive nucleic acid detection in precise antiviral therapy for patients with liver cirrhosis and its association with aminotransferase level. Methods A total of 377 patients with hepatitis B cirrhosis who were hospitalized or attended the outpatient service from May 2013 to April 2019 were enrolled and tested by both domestic HBV DNA detection and highly sensitive Cobas HBV DNA detection. All patients underwent biochemical examination,four blood coagulation tests,routine blood test,and upper abdominal computed tomography or ultrasound. Sensitivity of different HBV DNA detection reagents was compared in liver cirrhosis patients with a low viral load,and the correlation between alanine aminotransferase( ALT) level and viral load was analyzed.The paired t-test was used for comparison of continuous data before and after treatment. The receiver operating characteristic( ROC) curve was used to screen out the optimal predictive values of ALT at different cut-off values of HBV DNA. Results Among the 377 patients with hepatitis B cirrhosis,215 tested positive and 162 tested negative by domestic HBV DNA,and among these 162 patients,104( 64. 2%) tested positive by Cobas HBV DNA detection,with a mean level of 267. 5 ± 42. 3 IU/ml. After 24 weeks of antiviral therapy,the 104 patients with hepatitis B cirrhosis had significant improvements in viral replication level,ALT,and Child-Pugh score for liver function; HBV DNA decreased from 267. 5 ± 32. 2 IU/ml before treatment to 59. 6 ± 7. 7 IU/ml after treatment( t = 3. 486,P = 0. 002),ALT decreased from87. 1 ± 10. 8 U/L before treatment to 36. 5 ± 7. 6 U/L after treatment( t = 3. 235,P = 0. 020),and the Child-Pugh score decreased from6. 5 ± 0. 7 before treatment to 5. 7 ± 0. 5 after treatment( t = 2. 928,P = 0. 041). The ROC curve analysis of ALT in predicting HBV DNA decision point showed that an ALT level of 29 IU/L was the most sensitive cut-off value for predicting HBV DNA < 20 IU/ml,with an area under the ROC curve of 0. 904,a sensitivity of 1. 0,and a specificity of 0. 237. Conclusion Precise detection helps to guarantee the precise clinical treatment of patients with hepatitis B cirrhosis and improve their treatment outcome and prognosis. An ALT level of 29 IU/L is a sensitive indicator for predicting patients with negative Cobas HBV DNA,so as to achieve individualized precise screening and treatment.
- HBV DNA /
- alanine transaminase /
- liver cirrhosis /
- antiviral therapy

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参考文献(12)

[1] Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association. The guideline of prevention andtreatment for chronic hepatitis B:A 2015 update[J]. J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会，中华医学会感染病学分会．慢性乙型肝炎防治指南(2015年更新版)[J]．临床肝胆病杂志，2015,31(12):1941-1960.

[2] TERRAULT NA,BZOWEJ NH,CHANG KM,et al. AASLD guidelines for treatment of chronic hepatitis B[J]. Hepatology,2016,63(1):261-283.

[3] SARIN SK,KUMAR M,LAU GK,et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B:A 2015update[J]. Hepatol Int,2016,10(1):1-98.

[4] European Association for the Study of the Liver. EASL 2017clinical practice guidelines on the management of hepatitis B virus infection[J]. J Hepatol,2017,67(2):370-398.

[5] SHAO GH,YAN XQ,CHEN HM,et al. The clinical significance of high sensitivity HBV DNA detection for the treatment of antiviral therapy in patients with chronic hepatitis B[J/CD].Chin J Exp Clin Infect Dis(Electronic Edition),2016,10(1):46-48.(in Chinese)邵国辉，闫香芹，陈合民，等．高灵敏度HBV DNA检测指导慢性乙型肝炎患者抗病毒治疗的临床意义[J/CD]．中华实验和临床感染病杂志(电子版)，2016,10(1):46-48.

[6] ZHUANG H,WENG XH. Discussion of discontinuation of nucleoside and nucleoside analogs in the treatment of chronic hepatitis B[J]. Chin J Viral Dis,2013,3(4):241-244.(in Chinese)庄辉，翁心华．核苷酸类似药物治疗慢性乙型肝炎停药的探讨[J]．中国病毒病杂志，2013,3(4):241-244.

[7] LOK AS,MCMAHONAHON BJ. Chronic hepatitis B[J]. Hepatology,2007,45(2):507-539.

[8] NI JM,SUN M,WU XP. A comparative analysis of the HBV DNA test results of domestic quantitative real-time PCR and COBAS AmpliPrep/COBAS TaqMan V2. 0[J]. Chin J Clin Lab Sci,2014,32(5):398-399.(in Chinese)倪俊明，孙梅，吴旭平．国产荧光定量PCR与COBAS AmpliPrep/COBAS TaqMan V 2. 0检测HBV DNA结果比较[J]．临床检验杂志，2014,32(5):398-399.

[9] KIM JH,SINN DH,KANG W,et al. Low-level viremia and the increased risk of hepatocellular carcinoma in patients receiving entecavir treatment[J]. Hepatology,2017,66(2):335-343.

[10] TERRAULT NA,LOK A,MCMAHON BJ,et al. Update on prevention,diagnosis, and treatment of chronic hepatitis B:AASLD 2018 hepatitis B guidance[J]. Hepatology,2018,67(4):1560-1599.

[11] The Hepatitis Group,Chinese Society of Hepatology,Chinese Medical Association; Chinese Journal of Hepatology. An expert consensus for the adjustment of treatment strategies in patients with chronic hepatitis B treated with non-first-line nucleos(t)ide analogues[J]. J Clin Hepatol,2019,35(6):1212-1214.(in Chinese)中华医学会肝病学分会肝炎学组，中华肝脏病杂志．非一线核苷(酸)类似物经治慢性乙型肝炎患者治疗策略调整专家共识[J]．临床肝胆病杂志，2019,35(6):1212-1214.

[12] Chinese Society of Infectious Diseases,Chinese Medical Association; Chinese Society of Hepatology,Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(version 2019).[J]. J Clin Hepatol,2019,35(12):2648-2669.(in Chinese)中华医学会感染病学分会，中华医学会肝病学分会．慢性乙型肝炎防治指南(2019年版)．临床肝胆病杂志，2019,35(12):2648-2669.

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