经不同NAs治疗的慢性乙型肝炎患者HBV RNA的变化及差异-现代医学

经不同NAs治疗的慢性乙型肝炎患者HBV RNA的变化及差异

单位：1. 潍坊市人民医院感染性疾病科, 山东潍坊 261000;
2. 潍坊市益都中心医院消化内科, 山东潍坊 262500

分类号：R512.6+2

出版年·卷·期（页码）：2025·53·第十二期（1858-1863）

摘要：

目的：研究不同核苷(酸)类似物(NAs)治疗过程中慢性乙型肝炎(CHB)患者血清中乙肝病毒核糖核酸(HBV RNA)水平的变化及差异。方法：对2019年至2021年期间潍坊市益都中心医院就诊的80例CHB患者进行随访，分别接受恩替卡韦(ETV)和富马酸替诺福韦二吡呋酯(TDF)治疗，采用倾向性匹配调整干扰因素后，最终从两组中各选出27例患者进行分析，比较ETV和TDF治疗过程中患者血清HBV RNA水平的变化和差异。结果：在采用倾向性匹配之前，TDF组的丙氨酸转氨酶(ALT)水平为238 U·L^-1，高于ETV组123 U·L^-1，差异有统计学意义(P＜0.001)；TDF组的血清HBV RNA水平[(6.84±1.51)log₁₀ copies·mL^-1]、HBV DNA水平[(7.52±0.98)log₁₀ IU·mL^-1]均明显高于ETV组[(5.53±1.59)log₁₀ copies·mL^-1、(6.91±1.39)log₁₀ IU·mL^-1]，差异有统计学意义(P＜0.05)。匹配后两组的一般资料间的差异均无统计学意义(均P＞0.05)。在54例患者中，抗病毒治疗6个月后，血清HBV DNA的转阴率已达到92.59%，但血清HBV RNA的转阴率为0，HBV RNA的中位数为3.55 log₁₀ copies·mL^-1。在抗病毒治疗36个月后，血清HBV DNA的转阴率为100%，而血清HBV RNA的转阴率仅为22.22%，中位数为2.98 log₁₀ copies·mL^-1。应用ETV和TDF治疗的6、12、24、36个月，血清HBV RNA的下降幅度存在一定的差异，但差异均无统计学意义(均P＞0.05)。结论： CHB患者在长达36个月的抗病毒治疗后，仍可检测到血清HBV RNA的存在，需延长抗病毒治疗时间以有效抑制HBV RNA。在36个月的抗病毒治疗过程中，应用ETV和TDF治疗可能会使血清HBV RNA的下降幅度有所差异，但差异无统计学意义。

Objective: To investigate the changes and differences of serum hepatitis B virus ribonucleic acid(HBV RNA) levels in chronic hepatitis B(CHB) patients treated with different nucleos(t)ide analogues(NAs). Methods: A total of 80 CHB patients who visited Weifang Yidu Central Hospital from 2019 to 2021 were enrolled and assigned to entecavir(ETV) or tenofovir disoproxil fumarate(TDF) treatment groups. After propensity score matching to adjust for confounding factors, 27 patients from each group were included for analysis. Serum HBV RNA levels were compared between the two groups during antiviral therapy. Results: Before matching, the alanine aminotransferase(ALT) level of the TDF group was 238 U·L^-1, which was higher than that of the ETV group 123 U·L^-1, and the difference was statistically significant(P<0.001). The serum HBV RNA level [(6.84±1.51) log₁₀ copies·mL^-1] and HBV DNA level [(7.52±0.98) log₁₀IU·mL^-1] in the TDF group were significantly higher than those in the ETV group [(5.53±1.59) log₁₀ copies·mL^-1,(6.91±1.39) log₁₀ IU·mL^-1], and the differences were statistically significant(P<0.05). After matching, there were no significant differences in the general characteristics between the two groups(all P>0.05). Among the 54 patients, after 6 months of antiviral treatment, the rate of seroconversion to negative for HBV DNA had reached 92.59%, but the rate of seroconversion to negative for HBV RNA was 0, with a median value of 3.55 log₁₀ copies·mL^-1. After 36 months of antiviral treatment, the rate of seroconversion to negative for HBV DNA was 100%, while the rate of seroconversion to negative for HBV RNA was only 22.22%, with a median value of 2.98 log₁₀ copies·mL^-1. The decline in HBV RNA levels at months 6, 12, 24, and 36 did not differ significantly between ETV and TDF groups(all P>0.05). Conclusion: Serum HBV RNA can still be detected in CHB patients after antiviral treatment for up to 36 months, and it is necessary to extend the duration of antiviral treatment to effectively inhibit HBV RNA. During 36 months of antiviral therapy, ETV and TDF treatment may cause a difference in the reduction of serum HBV RNA, but the difference was not statistically significant.

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