摘要
目的观察行肝移植手术的乙型肝炎相关肝病患者肝移植术后乙型肝炎核心相关抗原(hepatitis B core-related antigen,HBcrAg)水平,探讨其对肝移植术后乙型肝炎病毒(hepatitis B virus,HBV)复发的预测价值。方法接受肝移植手术的乙型肝炎相关肝病患者196例,收集患者临床资料,检测术后HBcrAg水平和HBV-DNA阳性率。随访3年,根据患者是否出现HBV复发分为复发组21例和未复发组175例;比较2组患者临床资料,采用COX比例风险回归模型分析肝移植术后HBV复发的影响因素;绘制ROC曲线,评估HBcrAg、HBV-DNA水平在早期预测肝移植术后HBV复发的效能;采用Kaplan-Meier生存曲线分析肝移植术后不同HBcrAg水平患者HBV复发风险。结果196例患者中出现HBV复发21例,复发率为10.71%;复发组肝移植术后HBcrAg水平[5.5(4.1,7.5)log u/mL]、HBV-DNA阳性率(42.86%)、肝细胞癌比率(71.43%)高于未复发组[4.3(2.0,6.3)log u/mL、17.71%、45.14%](P<0.05);肝移植术后HBcrAg水平(HR=2.460,95%CI:1.332~4.542,P=0.004)、HBV-DNA阳性(HR=6.825,95%CI:2.505~18.593,P=0.007)和肝细胞癌(HR=6.916,95%CI:2.181~21.933,P=0.001)是肝移植术后HBV复发的影响因素;HBcrAg的最佳截断值为4.5 log u/mL、HBV-DNA为阳性、肝细胞癌时,预测肝移植术后HBV复发的AUC分别为0.818(95%CI:0.720~0.917,P<0.001)、0.626(95%CI:0.489~0.763,P=0.060)、0.631(95%CI:0.510~0.753,P=0.049),灵敏度分别为76.19%、42.86%、71.43%,特异度分别为77.14%、82.29%、54.86%;HBcrAg预测肝移植术后HBV复发的AUC高于HBV-DNA阳性和肝细胞癌(P<0.05);肝移植术后HBcrAg≤4.5 log u/mL患者3年内HBV复发风险(6.12%)明显低于HBcrAg>4.5 log u/mL患者(15.31%)(P<0.05)。结论HBcrAg水平可能是早期预测肝移植术后HBV复发的独立相关指标,可为临床制定治疗方案提供依据。
Objective To observe the level of hepatitis B core related antigen(HBcrAg)after liver transplantation in hepatitis B-related liver disease patients,and to investigate its value to the prediction of the relapse of hepatitis B virus(HBV)after liver transplantation.Methods The clinical data of 196 patients with hepatitis B-related liver disease undergoing liver transplantation were collected.The postoperative HBcrAg level and HBV-DNA positive rate were detected.All patients were followed up for 3 years,and were divided into HBV relapse group(n=21)and HBV no-relapse group(n=175).The clinical data were compared between two groups.COX proportional hazards regression model was used to analyze the influencing factors of HBV relapse.ROC was drawn to analyze the efficacies of HBcrAg and HBV-DNA on early prediction of HBV relapse after liver transplantation.Kaplan-Meier survival curve was used to analyze the risk of HBV relapse in patients with different HBcrAg levels after liver transplantation.Results In 196 patients,21 patients were found relapse,with a relapse rate of 10.71%.The postoperative HBcrAg level,HBV-DNA positive rate and hepatocellular carcinoma rate were higher in HBV relaspe group(5.5(4.1,7.5)log u/mL,42.86%,71.43%)than those in HBV no-relapse group(4.3(2.0,6.3)log u/mL,17.71%,45.14%)(P<0.05).The high postoperative HBcrAg level(HR=2.460,95%CI:1.332-4.542,P=0.004),positive HBV-DNA(HR=6.825,95%CI:2.505-18.593,P=0.007)and hepatocellular carcinoma(HR=6.916,95%CI:2.181-21.933,P=0.001)were the influencing factors of HBV relapse after liver transplantation.When the optimal cut-off value of HBcrAg was 4.5 log u/mL,HBV-DNA was positive,and hepatocellular carcinoma was present,the AUCs for predicting HBV relapse after liver transplantation were 0.818(95%CI:0.720-0.917,P<0.001),0.626(95%CI:0.489-0.763,P=0.060)and 0.631(95%CI:0.510-0.753,P=0.049),the sensitivities were 76.19%,42.86% and 71.43%,and the specificities were 77.14%,82.29% and 54.86%,respectively.The AUC of HBcrAg for predicting HBV relaspe after liver transplantation was higher than that of positive HBV-DNA and hepatocellular carcinoma(P<0.05).The risk of HBV relapse within 3 years in patients with HBcrAg≤4.5 log u/mL(6.12%)after liver transplantation was significantly lower than that in patients with HBcrAg>4.5 log u/mL(15.31)(P<0.05).Conclusion HBcrAg may be an independent and relevant indicator of early prediction of HBV relapse after liver transplantation,and it can provide a scientific basis for clinical treatment planning.
作者
米克热尼沙·艾海提
哈肖别克·卡斯木
Mikrenisha AIHITI;Khashobek KASMO(Department of Outpatient Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of General Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《中华实用诊断与治疗杂志》
2020年第12期1266-1269,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
新疆维吾尔自治区自然科学基金(2019D01C279)。
关键词
肝移植
乙型肝炎相关肝病
乙型肝炎病毒
乙型肝炎核心相关抗原
复发
liver transplantation
hepatitis B related liver disease
hepatitis B virus
hepatitis B core related antigen
relapse
