袁宇慧

[摘要] 目的 探讨HBeAg阳性及阴性患者血清HBV RNA水平对乙肝相关肝纤维化的影响，为早期肝纤维化诊断和预测提供新方案。 方法 选取2016年10月至2019年9月我院确诊的乙肝病毒感染的患者145例作为研究对象，进行HBV DNA、HBV RNA水平的检测;通过肝活检及相关生化指标评定肝纤维化分级、炎症分级和肝脏储备能力;通过多因素Logistic回归分析，明确独立危险因素;通过ROC曲线评价HBV RNA水平对乙肝相关肝纤维化预测的影响。 结果 HBeAg阳性患者的AST、ALT和 HBV DNA定量均顯著高于HBeAg阴性患者，差异有统计学意义（P<0.05）;在HBeAg阳性和阴性患者中，HBV RNA阳性组的肝纤维化分级、炎症分级和Child-Pugh分级均显著高于HBV RNA阴性组，差异有统计学意义（P<0.05）;多因素Logistic回归分析显示，HBeAg阳性和阴性患者的肝纤维化分级、炎症分级和Child-Pugh分级是影响HBV RNA的独立危险因素（P<0.05）;ROC曲线和效能评估检测发现，HBV RNA评估HBeAg阴性患者肝纤维化分级和炎症分级的曲线下面积（AUC）分别为0.721和0.763，特异度分别为69.5%和73.5%，敏感度为73.8%和75.4%。 结论 HBV RNA与乙肝肝纤维化具有相关性，对HBeAg阴性患者具有预测价值，值得临床推广。

[关键词] HBV RNA;肝纤维化;HBeAg;相关性分析

[中图分类号] R512.6          [文献标识码] A          [文章编号] 1673-9701（2021）08-0001-05

Analysis on the correlation between serum HBV RNA level and hepatitis B related hepatic fibrosis in HBeAg positive and negative patients

YUAN Yuhui

Department of Hepatology， Xuzhou Infectious Disease Hospital in Jiangsu Province， Xuzhou   221000， China

[Abstract] Objective To investigate the impacts of serum hepatitis B virus（HBV） RNA level and hepatitis B related hepatic fibrosis in HBeAg positive and negative patients， and to provide a new scheme for early diagnosis and prediction of hepatic fibrosis. Methods A total of 145 patients with confirmed HBV infection from October 2016 to September 2019 were selected as the research objects， and HBV DNA and HBV RNA levels were detected. The levels of fibrosis， inflammation and liver reserve capacity were evaluated by liver biopsy and related biochemical indexes. Through multivariate Logistic regression analysis， the independent risk factors were identified. ROC curve was used to evaluate the impacts of HBV RNA level on the prediction of hepatitis B related hepatic fibrosis. Results The levels of AST， ALT and HBV DNA in HBeAg positive patients were all significantly higher than those in HBeAg negative patients， with statistically significant differences（P<0.05）. In HBeAg positive and negative patients， the levels of hepatic fibrosis， inflammation and child-pugh in the HBV RNA positive group were significantly higher than those in the HBV RNA negative group， with statistically significant differences（P<0.05）. It was shown by multivariate Logistic regression analysis that the levels of hepatic fibrosis， inflammation and child-pugh were independent risk factors of HBeAg positive and negative patients impacting HBV RNA（P<0.05）. It was shown by ROC curve and efficacy evaluation that the area under the curve（AUC） of HBV RNA in evaluating the levels of hepatic fibrosis and inflammation in HBeAg negative patients was 0.721 and 0.763， the specificity was 69.5% and 73.5%， and the sensitivity was 73.8% and 75.4%（P<0.05）. Conclusion HBV RNA is correlated with hepatitis B hepatic fibrosis， and has predictive value for HBeAg negative patients， which is worthy of clinical promotion.

[Key words] HBV RNA; Hepatic fibrosis; HBeAg; Correlation analysis

慢性乙型肝炎病毒（Hepatitis B virus，HBV）感染是重要的公共卫生问题，极大程度地危及人们的生命财产安全[1]。慢性乙肝病毒感染患者具有很高的进展性肝纤维化、肝硬化甚至肝细胞癌（Hepatocellular carcinoma，HCC）的风险。因此，肝纤维化或肝硬化的早期诊断和严重程度评估对控制病情进展起着重要作用，有利于降低HBV感染相关终末期肝病的发病率和死亡率。现如今，肝组织活检是诊断肝纤维化或肝硬化的金标准，但由于肝组织活检作为一种有创检测，具有诸多局限性，如患者配合度较差、取样标本大小位置差异性较大等[2]，所以更便捷、无创的评估乙肝肝纤维化患者病情的方法是临床上迫切需要的。有研究表明，乙肝相关肝纤维化或肝硬化患者的血清HBV DNA处于低浓度状态，但与肝纤维化密切相关的共价闭合环状DNA（cccDNA）浓度仍较高，且复制活跃。由于肝组织内cccDNA分布不均及血清内双链DNA干扰，cccDNA的肝组织和血清检测难度大。……