摘要
目的:探讨核苷酸类似物(NAs)初治的HBeAg阳性患者发生HBeAg血清学转换的影响因素。方法:回顾性分析169例初次应用NAs抗病毒治疗至少2年且无病毒学突破的HBeAg阳性患者(中度慢性乙型肝炎患者153例,代偿性肝硬化患者16例),定期随访。应用寿命表法计算累计HBeAg血清学转换率,对影响HBeAg血清学转换的因素进行单因素、多因素Cox比例风险模型和Log-rank分层分析。结果:(1)HBeAg累积血清学转换率随着治疗时间的延长逐渐增高,1年、2年、3年HBeAg血清学累积转换率分别为21.07%、39.92%、54.48%。(2)基线年龄(P=0.005)、ALT(P=0.000)及病毒学应答时间(P=0.038)是影响HBeAg血清学转换的独立因素。(3)Log-rank分析结果:性别、家族史、基线诊断及NAs对HBeAg血清学转换无影响(P>0.05);基线ALT水平越高,越易获得HBeAg血清学转换(P<0.01);随着患者年龄的增加,其获得HBeAg血清学转换的概率越小(P=0.041);较晚获得病毒学应答的患者,其发生HBeAg血清学转换困难、滞后(P<0.01)。结论:延长抗病毒治疗时间有望获得更高的HBeAg血清学转换率,患者的年龄、基线ALT水平及病毒学应答发生的早晚可作为HBeAg血清学转换的预测因素。
Objective：To explore the clinical factors affecting HBeAg seroconversion（SC）in serum HBeAgpositive patients,after initial treatment using nucleoside analogues（NAs）.Methods：We retrospectively analyzed data from HBeAg-positive patients who received initial NAs treatment for at least 2years without viral breakthrough,including 153 medium chronic hepatitis B and 16 HBeAg-positive compensatory liver cirrhosis patients,Regular follow-up has been made for all patients.The cumulative rates of HBeAg SC were calculated by Life Tables.Univariate and multivariate Cox regression model were used to analyze the factors affecting HBeAg SC.Kaplan-Meier method was applied to analyze the independent risk factors.Results：The rate of HBeAg SC gradually became higher with prolonged treatment,and the cumulative rate of HBeAg SC of 1st,2nd and 3rd year of treatment were 21.07%、39.92%and 54.48%,respectively.Cox regression model showed that the baseline age（P =0.005）,baseline alanine aminotransferase（ALT）levels（P =0.000）and virological response（VR）time（P =0.038）were independent risk factors affecting HBeAg SC.Subgroup analysis showed that gender,family history,baseline diagnosis and NAs have no effect on HBeAg SC（P 〉0.05）.The younger the patient,the easier to acquire HBeAg SC（P〈 0.01）.The higher the baseline ALT level,the easier it is to get HBeAg SC（P =0.041）.The later occurrence of VR made patients more difficult and delayed to achieve the HBeAg SC（P 〈0.01）.Conclusion：The HBeAg SC rate is expected to be higher with longer treatment.HBeAg SC can be predicted from patient＇s age,baseline ALT levels and the occurrence to VR.
出处
《广西医科大学学报》
CAS
2016年第2期262-265,共4页
Journal of Guangxi Medical University
基金
广西自然科学基金资助项目(No.2014GXNSFDA118023)
