Department of Infectious Diseases, Peking University First Hospital, Beijing, China.
J Viral Hepat. 2020 Mar;27(3):323-328. doi: 10.1111/jvh.13227. Epub 2019 Nov 26.
We examined whether the hepatitis B virus (HBV) pregenomic RNA (pgRNA) status after nucleos(t)ide (NA) treatment can predict the long-time prognoses of chronic hepatitis B patients. Patients with chronic hepatitis B (98) who were treatment-naïve and had begun a 7-year NA therapy regimen were enrolled in this study. Biochemical indicators and serological markers of HBV infection were performed during therapy. HBV pgRNA was quantified by real-time quantitative PCR with specific primers. During treatment, HBV DNA undetectable rates increased. The aminotransferase (ALT) normalization (ALT < 50 IU/L) and HBeAg-negative rates also increased. After 48 weeks' NA treatment, 48.28% (28/58) of HBV DNA undetectable patients still had HBV pgRNA-positive. After 7 years of treatment, more HBV pgRNA-negative patients (n = 35) achieved HBeAg clearance than the patients who were HBV pgRNA-positive (n = 63) (19/23 vs 19/56, P < .00). HBV pgRNA-positive patients also had an increased risk of failing to achieve HBeAg clearance (OR = 9.25, 95% CI: 2.75-31.08). The median time to HBeAg clearance in the HBV pgRNA-positive patients was longer than that of the HBV pgRNA-negative patients (152 weeks vs 72 weeks). The HBV pgRNA-positive patients also required more time to achieve HBV DNA undetectable (124 weeks, 95% CI: 103.33-144.67 vs 48 weeks, 95% CI: 34.80-61.20). The HBV pgRNA status after NA treatment can predict the long-term prognoses of patients with chronic HBV. Patients who remain HBV pgRNA-positive after 48 weeks of NA treatment have an increased risk of not achieving HBeAg clearance, need more time to achieve HBeAg clearance and undetectable HBV DNA load.
我们研究了核苷（酸）治疗后乙型肝炎病毒（HBV）前基因组 RNA（pgRNA）状态是否可以预测慢性乙型肝炎患者的长期预后。本研究纳入了 98 例初治、开始接受 7 年核苷（酸）治疗方案的慢性乙型肝炎患者。治疗期间进行了乙型肝炎病毒感染的生化指标和血清学标志物检测。采用实时荧光定量 PCR 法和特异性引物检测 HBV pgRNA。治疗期间，HBV DNA 不可检测率增加，丙氨酸氨基转移酶（ALT）复常（ALT＜50IU/L）率和 HBeAg 阴性率也增加。NA 治疗 48 周后，仍有 48.28%（28/58）的 HBV DNA 不可检测患者 HBV pgRNA 阳性。治疗 7 年后，更多 HBV pgRNA 阴性患者（n=35）实现了 HBeAg 清除，而 HBV pgRNA 阳性患者（n=63）则较少（19/23 比 19/56，P＜.00）。HBV pgRNA 阳性患者 HBeAg 清除失败的风险也增加（OR=9.25，95%CI：2.75-31.08）。HBV pgRNA 阳性患者达到 HBeAg 清除的中位时间长于 HBV pgRNA 阴性患者（152 周比 72 周）。HBV pgRNA 阳性患者实现 HBV DNA 不可检测所需的时间也更长（124 周，95%CI：103.33-144.67 比 48 周，95%CI：34.80-61.20）。NA 治疗后 HBV pgRNA 状态可预测慢性乙型肝炎患者的长期预后。NA 治疗 48 周后仍为 HBV pgRNA 阳性的患者 HBeAg 清除失败风险增加，需要更多时间才能达到 HBeAg 清除和 HBV DNA 载量不可检测。
