高敏PCR在HBV极低病毒载量的慢性乙型肝炎患者中检测的临床意义
Significance of high-sensitivity polymerase chain reaction in detecting hepatitis B virus in chronic hepatitis B patients with a very low viral load
摘要
Abstract
Objective To investigate the significance of high-sensitive polymerase chain reaction(PCR)in detecting hepatitis B virus(HBV)among the population with a very low viral load(HBV DNA 10—99 IU/mL).Methods This study was conducted among the chronic hepatitis B(CHB)patients who were treated with nucleos(t)ide analogues for≥48 weeks in The Fifth Affiliated Hospital of Guangzhou Medical University from September 2019 to February 2022 and had an HBV DNA load below the lower limit of ordinary-sensitivity detection(100 IU/mL).Then high-sensitivity HBV DNA detection was performed for all patients,and according to these results,the patients were divided into very low viral load group(VLVL group with an HBV DNA load of 10—99 IU/mL)and complete virologic response group(CVR group with an HBV DNA load of<10 IU/mL or without HBV DNA detected).The two groups were compared in terms of general characteristics,serum virological indicators,biochemical parameters,and noninvasive fibrosis markers;the value of related serum virological indicators in predicting the results of high-sensitivity HBV DNA above the lower limit of detection were assessed;the influencing factors for failure to achieve CVR were analyzed.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups.The receiver operating characteristic(ROC)curve was used to investigate the value of related serum virological indicators in predicting the results of high-sensitivity HBV DNA above the lower limit of detection,and a binary logistic regression analysis was used to investigate the influencing factors for failure to achieve CVR.Results A total of 106 CHB patients were enrolled,with 24 in the VLVL group and 82 in the CVR group.Compared with the CVR group,the VLVL group had a significantly younger age(P=0.004)and significantly higher quantitative hepatitis B surface antigen(qHBsAg)level(P=0.002),HBeAg positive rate(P=0.002),pgRNA positive rate(P=0.010),and alanine aminotransferase level(P=0.017).The qHBsAg level had an area under the ROC curve of 0.717(P=0.002)in predicting the results of high-sensitivity HBV DNA above the lower limit of detection(>10 IU/mL),with an optimal cut-off value of 1214.5 IU/mL,a sensitivity of 95.5%,and a specificity of 53.9%.Positive HBeAg(odds ratio[OR]=3.654,95%confidence interval[CI]:1.162—11.489,P= 0.027)and qHBsAg(OR=2.985,95%CI:1.058—8.422,P=0.039)were independent influencing factors for failure to achieve CVR.Conclusion Some CHB patients have an HBV DNA load of<100 IU/mL by ordinary-sensitivity detection,but with the presence of VLVL determined by high-sensitivity PCR.The VLVL group had significantly higher level of inflammatory damage and positive rates of pgRNA and HBeAg.Positive HBeAg and high qHBsAg level are independent influencing factors for failure to achieve CVR.Clinicians should not ignore the presence of VLVL in CHB patients,and high-sensitivity HBV DNA detection should be performed in a timely manner.关键词
乙型肝炎,慢性/聚合酶链反应/极低病毒载量Key words
Hepatitis B,Chronic/Polymerase Chain Reaction/Very Low Viral Load引用本文复制引用
邱功钦,谢丹,陈姿任,欧阳石..高敏PCR在HBV极低病毒载量的慢性乙型肝炎患者中检测的临床意义[J].临床肝胆病杂志,2024,40(3):483-488,6.基金项目
国家自然科学基金(81803884) （81803884）
广东高校生物靶向诊治与康复重点实验室(2021KSYS009) （2021KSYS009）
广州市医学重点学科项目(2021-2023年) （2021-2023年）
本科生创新能力提升计划项目(2022JXA003) （2022JXA003）
广州医科大学科研能力提升项目(02-410-2302092XM) （02-410-2302092XM）
2022年广州医科大学学科建设项目(02-410-2206013) （02-410-2206013）
2023年市校(院)企联合资助项目(2023A03J0421) （院）
2023年北京肝胆相照公益基金会资助项目(iGandanF-1082023-RGG023) National Natural Science Foundation of China(81803884) （iGandanF-1082023-RGG023）
The Key Laboratory of Guangdong Higher Education Institutes(2021KSYS009) （2021KSYS009）
The Key Medical Disciplines of Guangzhou Project(2021—2023) （2021—2023）
Undergraduate Innovation Ability Enhancement Program Project(2022JXA003) （2022JXA003）
Plan on Enhancing Scientific Research in GMU(02-410-2302092XM) （02-410-2302092XM）
2022 Guangzhou Medical University Discipline Construction Projects(02-410-2206013) （02-410-2206013）
2023 City School(College)Enterprise Joint Funding Projects(2023A03J0421) （College）
The 2023 Artificial Liver Special Fund(iGandanF-1082023-RGG023) （iGandanF-1082023-RGG023）
