| 龙云,刘聪,卜琪,等.慢性乙型肝炎患者HBeAg血清学转换的影响因素及预测模型的建立[J].中国临床保健杂志,2019,22(5):637-640. |
| 慢性乙型肝炎患者HBeAg血清学转换的影响因素及预测模型的建立 |
| Establishment of influencing factors and predictive model of HBeAg seroconversion in patients with chronic hepatitis B |
| 投稿时间：2019-02-22 |
| DOI：10.3969/J.issn.1672-6790.2019.05.017 |
| 中文关键词: 乙型肝炎,慢性 乙型肝炎e抗原 影响因素分析 |
| 英文关键词: Hepatitis B,chronic Hepatitis Be Antigens Root cause analysis 〖FL |
| 基金项目:云南省科技厅基础和应用研究项目(2010ZC196) |
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| 中文摘要: |
| 目的 探讨慢性乙型肝炎(CHB)患者HBeAg血清学转换的影响因素,以及血清学转换的预测模型的建立。方法 研究收集初治CHB患者200例,所有患者均HBeAg阳性,监测肝功能血清学指标,包括HBV DNA以及丙氨酸氨基转移酶(ALT)。所有患者随访3年后,再次监测以上指标,将2次监测结果作对比,分析HBeAg转阴的影响因素。然后根据以上影响因素建立3年发生HBeAg转阴的预测模型。最后采用受试者表达ROC曲线评估预测模型的临床意义。结果 200例CHB患者在随访3年后,有87例患者转变为HBeAg阴性,每年转阴比例为14.5%；而55例患者表现为抗HBe转换,每年转换比例为9.2%；发生血清学转换患者的HBV DNA载量与ALT指标存在明显的降低,也有患者仍存在高拷贝HBV DNA载量,HBeAg转换率与HBV DNA载量呈负相关(P<0.05)；HBeAg转阴比例与年龄有关,6~20岁转换率较低,而后转换率随着年龄增加而升高,各组差异有统计学意义(P<0.05)。采用ALT、HBeAg ROC曲线,计算约登指数及临界值:ALT≥217 u/L与ALT<217 u/L,HBeAg≥313 S/CO与HBeAg<313 S/CO；建立CHB患者HBeAg转换预测评分系统,其ROC为0.753。评分范围:0~6分,<3分为低转换,≥3分为高转换。当约登指数最大,则临界值为3分时,其敏感性为63.2%,特异性为75.2%。通过研究所验证预测模型的ROC为0.766。结论 CHB患者HBeAg血清学转换的自然影响因素是年龄、ALT,利用其建立的HBeAg血清学转换预测模型具有一定的临床应用价值。 |
| 英文摘要: |
| Objective To investigate the influencing factors of HBeAg seroconversion in patients with chronic hepatitis B (CHB) and to establish a predictive model.Methods A total of 200 newly treated CHB patients were collected.All patients were confirmed to be positive for HBeAg.Serological indicators of liver function,including HBV DNA and alanine aminotransferase (ALT),were monitored.All patients were followed up for 3 years,then the above indicators were monitored again,serological indicators of hepatitis B were monitored by ELISA,HBV DNA load was measured by high-throughput real-time fluorescent quantitative PCR,and ALT was monitored by rate method.The two monitoring results were compared and the influencing factors of HBeAg negative were analyzed.Then,according to the above factors,a three-year prediction model of HBeAg negative was established.Finally,the clinical significance of the predictive model was assessed by using ROC curve expressed by subjects.Results HBeAg was positive in 200 patients with CHB.After 3 years of follow-up,87 patients turned negative for HBeAg,with a hegative rate of 14.5% per year.55 patients showed anti-HBe conversion,with an annual conversion rate of 9.2%.There was a significant decrease in HBV DNA load and ALT index in patients with seroconversion.There were also many patients with high copy HBV DNA load.HBeAg conversion rate was negative correlated with HBV DNA load.The rate of HBeAg negative conversion was related to age.The rate of HBeAg negative conversion was low between 6 to 20 years old,and then increases with age.There are significant differences among different groups with statistical significance.Gender was not the main influencing factors of HBeAg negative conversion.Using ALT and HBe ROC curve to calculate Youden index and critical value,ALT≥217 u/L and ALT<217 u/L,HBeAg≥313 S/CO and HBeAg<313 S/CO.Establish a predictive model of HBeAg conversion in CHB patients.The ROC was 0.753,and the scoring range was 0-6 points,less than 3 points for low conversion and more than 3 points for high conversion,when the Yoden index was the largest,the critical value is 3,the sensitivity was 63.2%,and the specificity was 75.2%.The ROC of the prediction model was 0.766 verified by the research institute.Conclusion The natural influencing factors of HBeAg serological conversion in CHB patients are age and ALT.The HBeAg serological conversion prediction model established by the model has high clinical significance. |
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