Wu Yongbin, Tang Guifang, Wen Jian, Wan Ying, Wang Yufei, Li Ling
Department of Laboratory Medicine, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China.
Department of Infectious Diseases, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China.
Virol J. 2025 May 5;22(1):132. doi: 10.1186/s12985-025-02712-y.
The role of hepatitis B virus (HBV) RNA in the management of patients with chronic hepatitis B (CHB) experienced with low-level viremia (LLV) remains poorly defined. This study was designed to evaluate the prognostic utility of serum HBV RNA as a biomarker for predicting treatment outcomes in this population.
A retrospective cohort analysis was conducted on 117 pediatric patients with LLV (mean age: 13.14 years; 34% female) treated with continuous entecavir (ConT) or modified regimens (switching to or combining with tenofovir disoproxil fumarate) for ≥ 120 weeks. Virological response was defined as HBV DNA < 10 IU/mL at week 120.
No significant baseline differences existed between ConT and modified regimen groups. Compared to ConT, modified regimens achieved greater reductions in serum HBV DNA, HBV RNA, and quantitative HBsAg, with higher cumulative undetectable rates at week 120 (HBV DNA: ≥ 80.0%; HBV RNA: ≥ 54.8%; P < 0.05). Notably, qHBsAg levels remained elevated in most patients, with only 3 individuals achieving undetectable levels (< 0.05 IU/mL). Multivariate analysis identified higher HBV RNA levels at week 48 as an independent risk factor for non-virological response (adjusted odds ratio: 5.86; 95% confidence interval: 1.40-24.62; P = 0.016). Although HBV RNA alone was less predictive than HBV DNA (area under the receiver operating characteristic curve [AUC]: 0.76 vs. 0.80; P = 0.459), combining both markers improved prediction accuracy (AUC: 0.82; P < 0.05 vs. single markers).
In children with LLV, serum HBV RNA level is an independent risk factor for non-virological response and may serve as a complementary biomarker to HBV DNA for guiding antiviral therapy adjustments.
乙型肝炎病毒（HBV）RNA在慢性乙型肝炎（CHB）低水平病毒血症（LLV）患者管理中的作用仍不明确。本研究旨在评估血清HBV RNA作为预测该人群治疗结局的生物标志物的预后效用。
对117例接受恩替卡韦持续治疗（ConT）或改良方案（换用或联合富马酸替诺福韦二吡呋酯）≥120周的LLV儿科患者（平均年龄：13.14岁；34%为女性）进行回顾性队列分析。病毒学应答定义为第120周时HBV DNA<10 IU/mL。
ConT组和改良方案组之间基线无显著差异。与ConT相比，改良方案使血清HBV DNA、HBV RNA和定量HBsAg降低幅度更大，第120周时累积不可检测率更高（HBV DNA：≥80.0%；HBV RNA：≥54.8%；P<0.05）。值得注意的是，大多数患者的qHBsAg水平仍升高，只有3例患者达到不可检测水平（<0.05 IU/mL）。多变量分析确定第48周时较高的HBV RNA水平是非病毒学应答的独立危险因素（调整比值比：5.86；95%置信区间：1.40 - 24.62；P = 0.016）。虽然单独的HBV RNA预测能力低于HBV DNA（受试者工作特征曲线下面积[AUC]：0.76对0.80；P = 0.459），但联合两种标志物可提高预测准确性（AUC：0.82；与单一标志物相比，P<0.05）。
在LLV儿童中，血清HBV RNA水平是非病毒学应答的独立危险因素，可作为HBV DNA的补充生物标志物用于指导抗病毒治疗调整。
