Study on early predictive factors of an incomplete viral response with 48 week-entecavir therapy in HBeAg-positive chronic hepatitis B patients
10.3760/cma.j.cn501113-20200907-00505
- VernacularTitle:HBeAg阳性慢性乙型肝炎患者恩替卡韦治疗48周病毒学不完全应答早期预测因素研究
- Author:
Zifan ZHOU
1
;
Yang DING
;
Chong ZHANG
;
Yaoxin FAN
;
Xiaoguang DOU
Author Information
1. 中国医科大学附属盛京医院感染科，沈阳 110022
- Keywords:
Hepatitis B, chronic;
Entecavir;
Complete virological response;
Partial virological response
- From:
Chinese Journal of Hepatology
2020;28(12):1008-1012
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the virological and serological indicators before treatment and 24 weeks after treatment to predict the partial virological response (PVR) of 48-week entecavir (ETV) treatment, and formulate early clinical adjustment treatment plans for HBeAg-positive CHB patients.Methods:HBeAg-positive CHB-na?ve patients diagnosed in the Department of Infectious Diseases, Shengjing Hospital, China Medical University, who were treated with oral ETV monotherapy from January 2018 were enrolled. The groups were divided according to the test results of HBV DNA at 48 weeks. Among them, HBV DNA < 20 IU/ml was the complete viral response (CVR) group, and HBV DNA ≥ 20 IU/ml was the PVR group. The virological and serological indexes of the two groups before treatment and 24 weeks after treatment were compared. ROC curve univariate analysis and multivariate logistic regression were performed to find out the early predictors of PVR in HBeAg-positive CHB patients receiving ETV therapy for 48 weeks.Results:As of July 2020, a total of 90 cases had completed 48 weeks of treatment, including 50 cases of CVR (55.56%) and 40 cases of PVR (44.44%). Before treatment and at 24 weeks of treatment, HBsAg, HBeAg and HBV DNA in the PVR group were significantly higher than those in the CVR group ( P < 0.001). Univariate analysis showed that HBV DNA quantification (AUC = 0.961, P < 0.001, PPV = 97.06%, NPV = 87.50%) and HBeAg quantification (AUC = 0.883, P < 0.001, PPV = 90.63%, NPV = 81.03%) had higher predictive value at 24 weeks of treatment. Multivariate analysis showed that HBeAg > 1.952 log 10 S/CO ( OR = 3.177, 95% CI: 1.261 ~ 8.267, P = 0.018) and HBV DNA > 2.205 log 10 IU / ml ( OR = 43.197, 95% CI: 6.858 ~ 272.069, P < 0.001) were independent predictors of PVR at 24 weeks of treatment, and their combination had the best predictive effect. Conclusion:In HBeAg-positive CHB patients receiving ETV treatment for 48 weeks, HBV DNA combined with HBeAg quantification can be an early predictor of PVR at 24 weeks. Additionally, patients with both HBV DNA and HBeAg > 2 log 10 at 24 weeks of treatment must wait 48 weeks to obtain CVR, so it is recommended that treatment strategies should be adjusted at this time.
