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摘要：
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摘要：目的 探讨核苷（酸）类似物 [nucleos(t)ide analogues，NAs] 治疗代偿期乙型肝
炎肝硬化患者过程中患者血清HBV RNA水平变化及临床意义。方法 选择2012年7月
至2014年6月首都医科大学附属北京地坛医院接受NAs治疗的51例代偿期乙型肝炎肝
硬化的患者为研究对象，分别检测治疗前及治疗182周时丙氨酸氨基转移酶（alanine
aminotransferase，ALT）、天门冬氨酸氨基转移酶（aspartate aminotransferase，AST）、
乙型肝炎病毒表面抗原（hepatitis B virus surface antigen，HBsAg）、乙型肝炎病毒e
抗原（hepatitis B virus e antigen，HBeAg）、乙型肝炎病毒e抗体（hepatitis B virus e
antibody，HBeAb）、HBV DNA及血清HBV RNA水平，采用Spearman相关分析血清
HBV RNA水平与ALT、HBsAg、HBV DNA水平的相关性。结果 ①接受NAs治疗182周
时，血清ALT（中位数：19.7 U/L vs 58.1 U/L）、AST（中位数：20.9 U/L vs 47.0 U/L）
及HBsAg （3.13 ± 0.43 log10 IU/ml vs 3.38 ± 0.40 log10 IU/ml）水平较基线显著降低，差异
有统计学意义（P均＜ 0.05），HBV DNA阴转率为93.62%（44/47）。②接受NAs治疗
182周时血清HBV RNA水平与基线差异无统计学意义 [（3.86 ± 1.07）log10 IU/ml vs （4.22 ±
1.28）log10 IU/ml；t = 1.56，P = 0.13]。③治疗182周时，HBeAg未阴转组与阴转组（中
位数：3.2 log10 IU/ml vs 3.5 log10 IU/ml）、HBeAg未发生血清学转换组与发生转换组（中
位数：3.2 log10 IU/ml vs 3.5 log10 IU/ml）间血清HBV RNA水平差异均无统计学意义（P
均＞ 0.05）。④患者基线血清HBV RNA与ALT、HBsAg、HBV DNA水平均无相关性（r =
0.14，P = 0.36；r = 0.05，P = 0.75；r = 0.05，P = 0.77）。结论 血清HBV RNA水平变化
在代偿期乙型肝炎肝硬化患者NAs抗病毒治疗效果评估及预测方面无明显意义。
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Abstract: Objective To investigate the changes and clinical value of serum HBV RNA levels
on patients with compensatory hepatitis B cirrhosis treated with nucleos(t)ide analogues (NAs).
Methods A total of 51 patients with compensatory hepatitis B cirrhosis who received NAs
treatment in Beijing Ditan Hospital, Capital Medical University from July 2012 to June 2014
were selected. Alanine aminotransferase (ALT) level, aspartate aminotransferase (AST) level,
hepatitis B virus surface antigen (HBsAg), hepatitis B virus e antigen (HBeAg), hepatitis B virus
e antibody (HBeAg), hepatitis B virus e antibody (HBeAb), HBV DNA level and HBV RNA
level were detected before and after 182 weeks of NAs treatment. Spearman correlation analysis
was used to investigate the correlations between serum HBV RNA level and HBsAg, ALT level
and HBV DNA level. Results ①The serum level of ALT (median: 19.7 U/L vs 58.1 U/L), AST
(median: 20.9 U/L vs 47.0 U/L) and HBsAg (3.13 ± 0.43 log10 IU/ml vs 3.38 ± 0.40 log10 IU/ml)
of patients at 182 weeks after treatment reduced significantly compared with those of baseline,
the differences were statistically significant (all P ＜ 0.05). The negative conversion rate of
HBV DNA was 93.62% (44/47). ②There was no statistical difference in serum HBV RNA level
of patients between baseline and 182 weeks after treatment [(3.86 ± 1.07) log10 IU/ml vs (4.22 ±
1.28) log10 IU/ml; t = 1.56, P = 0.13]. ③There was no statistically significant difference in serum
HBV RNA level between patients with and without negative conversion of HBeAg (median:
3.2 log10 IU/ml vs 3.5 log10 IU/ml; P ＞ 0.05), and there was no statistically significant difference
in serum HBV RNA level between HBeAg seroconversion group and non-seroconversion group
(median: 3.2 log10 IU/ml vs 3.5 log10 IU/ml; P ＞ 0.05). ④There were no correlations between
baseline serum HBV RNA level and ALT level, HBsAg, HBV DNA level of the patients (r =
0.14, P = 0.36; r = 0.05, P = 0.75; r = 0.05, P = 0.77). Conclusions The changes of serum HBV
RNA level had no significance on evaluating or predicting the efficacy of NAs antiviral therapy
in patients with compensatory hepatitis B cirrhosis.
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