极低病毒血症慢性乙型肝炎患者与pgRNA和sPD-L1水平的关联

Association of very low-level viremia with pgRNA and sPD-L1 levels of patients with chronic hepatitis B

    摘要
  • 摘要:
    目的 评估HBV前基因组RNA（pgRNA）、可溶性程序性死亡配体1（sPD-L1）对慢性乙型肝炎（CHB）患者极低病毒血症（VLLV）状态的诊断价值。
    方法 回顾性分析2024年10月－2026年1月淄博市第一医院感染性疾病科门诊就诊的核苷（酸）类似物（NAs）治疗的315例CHB患者的临床资料，根据患者近一年内高敏HBV DNA检测结果分为持续病毒学应答（SVR）组（n=189）和VLLV组（n=126），检测两组患者pgRNA、sPD-L1水平，分析CHB患者VLLV状态的危险因素并进行HBeAg分层的探索性亚组分析；采用受试者工作特征（ROC）曲线评估pgRNA、sPD-L1对CHB患者VLLV的诊断价值。
    结果 CHB患者中SVR组患者年龄、FIB-4高于VLLV组患者（P＜0.05），SVR组患者ALT、HBsAg定量值(lg HBsAg)、HBeAg阳性率、pgRNA定量值(lg pgRNA)和sPD-L1定量值（lgsPD-L1）均低于VLLV组患者（P＜0.05），在多因素调整后，年龄（OR=0.967）、HBeAg阳性（OR=2.361）、lgpgRNA（OR=1.469）是CHB患者VLLV状态的危险因素（P＜0.05）。lgpgRNA和lgsPD-L1联合模型诊断CHB患者VLLV状态的ROC曲线下面积为0.831，高于单独检测（P＜0.05）；lgpgRNA（OR=1.623）是HBeAg阴性CHB患者VLLV状态的危险因素（P＜0.001）。
    结论 年龄、HBeAg阳性、pgRNA是CHB患者VLLV状态的危险因素，pgRNA联合sPD-L1筛查CHB患者VLLV状态阴性预测值高，pgRNA是HBeAg阴性CHB患者VLLV状态的危险因素。

     

    Abstract:
    OBJECTIVE To evaluate the value of HBV pregenomic RNA （pgRNA） and soluble programmed death ligand 1 （sPD-L1） in diagnosing the status of very low-level viremia （VLLV） in patients with chronic hepatitis B （CHB）.
    METHODS The clinical data of 315 CHB patients, who received nucleos（t）ide analogues （NAs） at the outpatient clinic of the department of infectious diseases in Zibo First Hospital between Oct. 2024 and Jan. 2026, were retrospectively analyzed. Patients were divided into a sustained virological response （SVR） group （n=189） and a VLLV group （n=126） based on their high-sensitivity HBV DNA test results within the past year. The levels of pgRNA and sPD-L1 were measured in both groups, and the risk factors for VLLV status in CHB patients were analyzed. Subsequently, an exploratory subgroup analysis stratified by HBeAg status was performed. Receiver operating characteristic （ROC） curves were adopted to evaluate the diagnostic value of pgRNA and sPD-L1 for VLLV in CHB patients.
    RESULTS Among CHB patients, those in the SVR group had significantly higher age and FIB-4 levels than those in the VLLV group （P＜0.05）. The ALT, HBeAg positivity rate, and the log10-transformed levels of HBsAg （lg HBsAg）, pgRNA （lg pgRNA） and sPD-L1 （lgsPD-L1） were lower in the SVR group than in the VLLV group （P＜0.05）. Multivariable adjustment revealed that age （OR=0.967）, HBeAg positivity （OR=2.361） and lg pgRNA （OR=1.469） were identified as risk factors for VLLV status in CHB patients （P＜0.05）. The area under the ROC curve for the combined model of lg pgRNA and lgsPD-L1 in diagnosing VLLV status in CHB patients was 0.831, which was significantly higher than that of either marker alone （P＜0.05）. Additionally, lg pgRNA （OR=1.623） was identified as a risk factor for VLLV status in HBeAg-negative CHB patients （P＜0.001）.
    CONCLUSIONS Age, HBeAg positivity and pgRNA are risk factors for VLLV status in CHB patients. The combination of pgRNA and sPD-L1 screening exhibits a high negative predictive value for VLLV status in CHB patients, and pgRNA is a risk factor for VLLV status in HBeAg-negative CHB patients.

     

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