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目的探索在新疆多民族聚居、人群背景因素复杂的情况下,乙型肝炎表面抗原(HBsAg)作为抗病毒疗效评价指标的应用价值及影响因素。方法回顾性分析新疆医科大学附属中医医院肝病科2012年1月-2013年8月期间住院就诊并初次使用核苷(酸)类似物进行治疗的慢性乙型肝炎(慢乙肝)患者临床资料,分析患者接受治疗后病毒学、血清学、生化学的变化情况,并分析其与HBsAg下降情况的关系,及治疗过程中HBsAg下降情况受影响的因素。结果共纳入乙型肝炎病毒慢性感染者63例。治疗48周时,所有患者均维持生化学应答,59例获得病毒学应答,另有4例获得部分病毒学应答,在其中的30例乙型肝炎e抗原(HBe Ag)阳性患者中,5例出现HBe Ag血清学转换。相关及回归分析结果显示病史(P=0.033)与治疗48周时的HBe Ag水平(P<0.001)为48周时的HBsAg水平的独立影响因素,而48周时HBsAg的下降程度受48周HBsAg水平的独立影响。21例治疗至72周的患者均维持了生化学应答,其中18例患者获得了病毒学应答,其余3例患者仍维持部分病毒学应答。8例HBe Ag阳性患者均未发生HBe Ag抗原消失或者血清学转换。相关及回归分析结果显示72周时HBsAg的水平受48周HBsAg水平影响(r=0.700,P<0.001),而72周HBsAg下降程度受基线HBsAg的影响。结论慢乙肝患者接受核苷(酸)类似物进行抗病毒治疗可以获得满意疗效。HBsAg单独作为患者接受抗病毒治疗时肝内共价闭合环状DNA(ccc DNA)的衡量指标需要考虑病史、HBe Ag的变化、HBsAg自身变化等因素的影响,并非只与肝内ccc DNA有关。
Objective To explore the value and influencing factors of hepatitis B surface antigen (HBsAg) as an antiviral therapeutic index under the condition of multi-ethnic population and complicated population background in Xinjiang. Methods The clinical data of patients with chronic hepatitis B (chronic hepatitis B) who were treated in our hospital from January 2012 to August 2013 in Department of Hepatology, Chinese Medicine Hospital Affiliated to Xinjiang Medical University were retrospectively analyzed. The virological, serological and biochemical changes of patients after treatment were analyzed and their relationship with the decline of HBsAg and the factors that affected the decline of HBsAg in the course of treatment were analyzed. Results A total of 63 chronic hepatitis B patients were included. At 48 weeks of treatment, all patients maintained a biochemical response, 59 received virological response, and 4 received partial virologic response. Among 30 of the 30 HBeAg positive patients, 5 HBeAg seroconversion occurred. Correlation and regression analysis showed that HBeAg level (P = 0.033) and HBeAg level at 48 weeks (P <0.001) were independent influencing factors of HBsAg level at 48 weeks, while HBsAg level decreased 48 weeks after HBsAg Horizontal independent influence. The biochemical response was maintained in 21 patients treated to 72 weeks, with 18 patients having virologic response and the remaining 3 patients remaining partially virologically responsive. None of the 8 HBeAg-positive patients had HBe Ag antigen disappearance or seroconversion. Correlation and regression analysis showed that the level of HBsAg was influenced by HBsAg level at 48 weeks (r = 0.700, P <0.001) at 72 weeks, while the level of HBsAg at 72 weeks was affected by baseline HBsAg. Conclusion Patients with chronic hepatitis B receiving nucleoside (acid) analogues for antiviral therapy can obtain satisfactory results. HBsAg alone as a measure of intrahepatic covalent closed circular DNA (ccc DNA) in patients receiving antiviral therapy need to consider the history, changes in HBeAg, HBsAg self-change and other factors, not only with the intrahepatic ccc DNA.