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Influence of baseline HBV DNA level on the clinical outcome of patients with compensated hepatitis B cirrhosis after antiviral therapy
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摘要: 目的分析基线HBV DNA水平对代偿期乙型肝炎肝硬化患者抗病毒治疗后临床转归的影响。方法选取首都医科大学附属北京友谊医院肝病中心2005年-2015年代偿期乙型肝炎肝硬化患者106例,给予核苷和核苷酸类药物抗病毒治疗,对患者进行前瞻性随访观察3年。按治疗前HBV DNA水平将患者分为3组,即HBV DNA<105IU/ml组、105107IU/ml组和>107IU/ml组。比较3组患者基线特征、抗病毒治疗疗效及肝脏相关终点事件（LREs）发生率。组间比较采用重复测量资料的方差分析或Friedman Test检验;计数资料组间比较采用χ2检验。采用Kaplan-Meier法计算LREs发生率并绘制生存曲线,各组之间的比较采用log-rank对数秩检验。结果 3组患者在年龄、性别、HBeAg、生化指标、肝脏硬度及CTP评分上差异均无统计学意义（P值均>0.05）。HBV DNA水平随时间的变化趋势差异有统计学意义（F=8.35,P<0.05）;3组间比较HBV DNA水平的变化差异也有统计学意义（F=13.95,P<...Abstract: Objective To investigate the influence of baseline HBV DNA level on the clinical outcome of patients with compensated hepatitis B cirrhosis after antiviral therapy. Methods A total of 106 patients with compensated hepatitis B cirrhosis who were treated in Liver Research Center, Beijing Friendship Hospital, Capital Medical University from 2005 to 2015 were enrolled and were given antiviral therapy with nucleos ( t) ide analogues. A three-year prospective follow-up was performed for all patients. According to the baseline HBV DNA level, the patients were divided into HBV DNA < 105 IU/ml group, 105-107 IU/ml group, and > 107 IU/ml group. The three groups were compared in terms of baseline characteristics, outcome of antiviral therapy, and incidence rate of liver-related events ( LREs) . A repeated-measures analysis of variance or the Friedman rank sum test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to calculate the incidence rates of LREs and plot survival curves, and the log-rank test was used for comparison between groups. Results There were no significant differences between the three groups in age, sex, HBeAg, biochemical parameters, liver stiffness, and Child-Turcotte-Pugh score ( all P >0. 05) . There were significant differences between the three groups in the change trend of HBV DNA level ( F = 8. 35, P < 0. 05) and the degree of such change ( F = 13. 95, P < 0. 05) . At 6 months of treatment, all three groups had a significant reduction in HBV DNA level, and the HBV DNA < 105 IU/ml group and the 105-107 IU/ml group achieved a median HBV DNA level of below the limit of detection, while the HBV DNA > 107 IU/ml group achieved such a level at 12 months of treatment. At 12 and 24 months of treatment, there was no significant difference in HBV DNA clearance rate between the three groups ( χ2= 5. 97 and 6. 84, both P > 0. 05) ; at 36 months of treatment, there was a significant difference in HBV DNA clearance rate between the three groups ( 95. 7% vs 88. 0% vs 77. 8%, χ2= 12. 75, P < 0. 05) . There was no significant difference in the incidence rate of LREs between the three groups ( P > 0. 05) . Conclusion Patients with compensated hepatitis B cirrhosis have a significant reduction in HBV DNA level after antiviral therapy. Although patients with a high level of replication have slow virologic response, baseline HBV DNA level has no influence on the incidence rate of LREs within 3 years of antiviral therapy.
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Key words:
- liver cirrhosis /
- hepatitis B, chronic /
- HBV DNA /
- antiviral therapy
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