Relationship Between Early Dynamic Changes Of HBV RNA And TH1/2 Cytokines And Prognosis Of HBV-(S)ACLF

BackgroundThe model of end-stage liver disease(MELD)is the main scoring method for the prognosis of liver failure,but with the development of diagnosis and treatment technology,it is necessary to explore new indicators to further improve the prognosis of patients with liver failure.This study was conducted to investigate the predictive role of hepatitis B virus(HBV)RNA and helper T lymphocyte type 1/2(Th1/2)factors in the prognosis of patients with HBV related(sub)acute chronic liver failure(ACLF).MethodsHBV-(s)ACLF case data and serum collection:hospitalized patients diagnosed with HBV-(s)ACLF in the Second Affiliated Hospital of Chongqing Medical University from June 1,2020 to February 28,2021.According to the survival condition of patients after 3 months of admission,they were divided into survival group and death group,and the total number of cases was 82.All patients received or continued nucleoside analogue antiviral therapy after admission.The data of patients’ medical records were collected,and blood samples(5ml/time)were collected at the first and fourth weeks of admission.The levels of HBV RNA,Hepatitis B surface antigen(HBsAg)and TH1/2 cytokines were measured.Patients were followed up at 1,4,8,12 and 24 weeks after admission,and the effects of HBV RNA,HBsAg and TH1/2 cytokines on prognosis were observed within one month.Data analysis:statistical analysis and drawing were carried out with spss26.0,statase12.0 and graphpad prism 7.00 software.The levels of HBsAg,HBV DNA and HBV RNA were logarithmic transformed for analysis.The data conforming to normal distribution are represented by mean ±standard deviation,and non-conforming data are represented by median[quartile range(IQR)].All statistical tests were bilateral tests and were evaluated with 0.05 significance level.ResultsThere were significant differences in baseline age,prothrombin time(PT),PTA,INR,TBIL,neutrophil(Ne)count and lymphocyte(Lym)absolute value between survival group and death group(P<0.05).HBV DNA quantity was inversely compared with survival rate in patients with HBV DNA≥ 6.5 1g IU/ml(P<0.05).At the 4th week after admission,there was a significant difference in the change of HBV RNA between survival group and death group,and HBV RNA decreased in survival group,but not in death group(P<0.05).The level of IFN-γ in survival group was significantly higher than that in death group at the 4th week(P<0.05).The level of IFN-γ in survival group showed an upward trend within one month,while that in death group showed a downward trend;PT,PTA,INR,TBIL,ALT,AST,MELD,WBC,Ne,PLT and Lym were significantly different between the two groups at the 4th week(P<0.05).Age,PTA and TBil were independent prognostic factors in baseline variables(P<0.05).HBV RNA combined with IFN-γ could significantly improve the accuracy of MELD score in evaluating the prognosis of patients(P<0.05);the area under the receiver operating characteristic curve(ROC)of HBV DNA score was increased compared with MELD score,and HBV DNA may be valuable in evaluating the prognosis of patients.ConclusionHBV-(S)ACLF patients with decreased HBV RNA at early stage have higher survival rate.HBV-(S)ACLF patients with elevated IFN-γin the early stage have a higher survival rate.The combination of HBV RNA and IFN-y is valuable in evaluating the prognosis of patients with HBV-(S)ACLF,and can improve the accuracy of MELD score in evaluating the prognosis of patients.The survival rate of HBV-(S)ACLF patients with early decrease of HBsAg was improved.