慢性乙型肝炎与乙肝肝硬化HBV RNA和HBV DNA的差异及相关性分析

目的 探讨慢性乙型肝炎（chronic hepatitis B,CHB）与乙肝肝硬化乙型肝炎病毒RNA（HBV RNA）和乙型肝炎病毒DNA（HBV DNA）之间的差异及相关性。方法 选取33例CHB为对照组,25例乙肝肝硬化为观察组,两组患者均持续使用强效核苷及核苷酸类药物（Nucleostide Analogues,NAs）治疗半年以上,比较两组HBV RNA、HBV DNA和乙肝病毒表面抗原（hepatitis B surface antigen,HBsAg）阳性率及表达水平。并采用Spearman法对HBV RNA、HBV DNA、HBsAg、肝功指标进行相关性分析,ROC曲线分析各指标在乙肝肝硬化中的诊断价值。结果 观察组HBV RNA、HBV DNA阳性率、天门冬氨酸氨基转移酶（aspartate transaminase,AST）的表达水平均高于CHB组,差异均有统计学意义（P<0.05）;其他指标之间均无统计学意义（P>0.05）。相关性分析显示观察组HBV RNA与HBV DNA呈正相关（r=0.715,P<0.01）,与其余肝功指标均无相关性（P>0.05）。ROC曲线分析HBV RNA、HBV DNA与AST对乙肝肝硬化的鉴别诊断曲线下面积AUC分别为0.746（95%CI：0.613~0.880）、0.729（95%CI：0.591~0.866）和0.640（95%CI：0.494~0.786）,HBV RNA联合HBV DNA鉴别诊断乙肝肝硬化的AUC为0.754（95%CI：0.623~0.885）面积最大,诊断价值最高。结论 乙肝肝硬化与CHB的HBV RNA和HBV DNA水平存在明显差异,两者联合在CHB与乙肝肝硬化的鉴别诊断价值更高,HBV RNA可考虑作为常规检测在临床推广。

The difference and correlation between HBV RNA and HBV DNA in patients with CHB and hepatitis B cirrhosis

Objective To explore the difference and correlation between HBV RNA and HBV DNA in patients between chronic hepatitis B （CHB） and hepatitis B cirrhosis. Methods 33 patients with CHB were selected as the control group, 25 patients with hepatitis B cirrhosis were selected as the observation group. Both groups were treated with potent nucleoside and nucleostide analogues（NAs） for more than half a year. The positive rates and expression levels of HBV RNA, HBV DNA and hepatitis B surface antigen （HBsAg） were compared between the two groups. The Spearman method was used to analyze the correlation of HBV RNA, HBV DNA, HBsAg and liver function indexes. The ROC curve was used to analyze the diagnostic value of each index in hepatitis B cirrhosis. Results The positive rates of HBV RNA and HBV DNA and the expression levels of aspartate transaminase （AST） in the observation group were higher than those in the CHB group, the differences were statistically significant （P<0.05）. There was no statistical significance among other indicators （P>0.05）. Correlation analysis showed that HBV RNA in the observation group was positively correlated with HBV DNA （r=0.715, P<0.01）, but had no correlation with other liver function indexes （P>0.05）. The area under the curve AUC of HBV RNA, HBV DNA and AST for differential diagnosis of hepatitis B cirrhosis by ROC curve analysis was 0.746 （95%CI： 0.613~0.880）, 0.729 （95%CI： 0.591~0.866） and 0.640 （95%CI： 0.494~0.786）. The AUC of HBV RNA combined with HBV DNA in the differential diagnosis of hepatitis B cirrhosis was 0.754 （95%CI： 0.623~0.885） with the largest area and the highest diagnostic value. Conclusion There are significant differences in the levels of HBV RNA and HBV DNA between hepatitis B cirrhosis and CHB. The combination of the two has a higher value in the differential diagnosis of CHB and hepatitis B cirrhosis. HBV RNA can be considered as a routine test applled for clinical promotion.