Xu Liang, Yin Bin, Chen Dandan, Xiong Xia, Yang Yongfeng, Wu Xuping
The Precision Medical Center, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, No. 1-1 Zhongfu Road, Gulou District, Nanjing, Jiangsu Province, 210003, China.
Department of Liver Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine; and The Clinical Infectious Disease Center of Nanjing, No. 1-1 Zhongfu Road, Gulou District, Nanjing, Jiangsu Province, 210003, China.
Clin Res Hepatol Gastroenterol. 2025 Jul-Aug;49(7):102648. doi: 10.1016/j.clinre.2025.102648. Epub 2025 Jul 12.
BACKGROUND AND OBJECTIVE(S): HBV RNA serve as a downstream transcriptional product of cccDNA within the liver. This study is the first to investigate the diagnostic significance of serum HBV RNA in HBV low-level viremia (LLV) patients, elucidating the interrelationships among serum HBV RNA, HBV DNA, and HBsAg.
A cohort of 514 HBV LLV patients was collected from The Second Hospital of Nanjing and divided into four groups: asymptomatic HBV carriers (ASC), chronic hepatitis B (CHB), liver cirrhosis (LC), and hepatocellular carcinoma (HCC). All were tested and analyzed for HBV RNA, HBV DNA, HBsAg, HBeAg, and liver function.
serum pathological indicators showed statistically significant differences included RNA, DNA, HBsAg, HBeAg-positive, TBIL, DBIL, IBIL, TP, ALB, ALT, AST, ALP, GGT (P < 0.001), and HBeAg-negative (P = 0.019). Both HBV RNA and HBV DNA were positively correlated with HBsAg (r = 0.405, P < 0.001; r = 0.198, P < 0.001). The correlation between HBV RNA and HBsAg was stronger than that between HBV DNA and HBsAg, and this difference became more pronounced after stratifying patients based on disease progression stages. This was also the case in different HBeAg states. We further conducted multivariate logistic regression analysis, and the results showed that RNA had strong statistical significance in the ASC and CHB groups (P < 0.001).
Monitoring HBV RNA levels holds certain value in assessing antiviral therapy efficacy and predicting disease progression stages and clinical outcomes in HBV LLV patients.
乙肝病毒RNA（HBV RNA）是肝脏内共价闭合环状DNA（cccDNA）的下游转录产物。本研究首次探讨血清HBV RNA在乙肝病毒低水平病毒血症（LLV）患者中的诊断意义，阐明血清HBV RNA、HBV DNA和乙肝表面抗原（HBsAg）之间的相互关系。
从南京医科大学第二附属医院收集514例HBV LLV患者，分为四组：无症状乙肝携带者（ASC）、慢性乙型肝炎（CHB）、肝硬化（LC）和肝细胞癌（HCC）。对所有患者进行HBV RNA、HBV DNA、HBsAg、乙肝e抗原（HBeAg）和肝功能的检测与分析。
血清病理学指标差异有统计学意义的包括RNA、DNA、HBsAg、HBeAg阳性、总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）、总蛋白（TP）、白蛋白（ALB）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（GGT）（P < 0.001）以及HBeAg阴性（P = 0.019）。HBV RNA和HBV DNA均与HBsAg呈正相关（r = 0.405，P < 0.001；r = 0.198，P < 0.001）。HBV RNA与HBsAg的相关性强于HBV DNA与HBsAg的相关性，且在根据疾病进展阶段对患者进行分层后，这种差异更为明显。在不同的HBeAg状态下也是如此。我们进一步进行多因素logistic回归分析，结果显示RNA在ASC和CHB组具有很强的统计学意义（P < 0.001）。
监测HBV RNA水平对评估抗病毒治疗疗效以及预测HBV LLV患者的疾病进展阶段和临床结局具有一定价值。
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