Influencing Factors For The Partial Virological Response Of Chronic Hepatitis B Patients Treated With Nucleos(t)ide Analogs

Objective:To investigate the influencing factors for partial virological response(PVR)in chronic hepatitis B(CHB)patients treated with nucleos(t)ide analogs(NAs),evaluate the predictive value of each independent influence factor for PVR,and analyze the dynamic changes of clinical indicators,so that provide theoretical basis for the early diagnosis and treatment of PVR.Methods:CHB patients who received NAs antiviral therapy for at least 48 weeks in the outpatient department of infection,the First Affiliated Hospital of Nanchang University from September 2019 to January 2022 were selected.According to the HBV DNA level during the treatment,the patients were divided into complete virological response(CVR)group and PVR group.Demographic characteristics and laboratory test indexes of patients were observed.The independent influencing factors of PVR were analyzed by multivariate logistic regression,and the receiver operating characteristic(ROC)curve was used to evaluate the prediction efficiency of them.The cumulative rates of HBV DNA undetectable were calculated using the Kaplan-Meier.Results:1.Among the 101 patients with CHB,there were 29 patients with PVR and 72 patients with PVR.Univariate analysis showed that there were significant differences in age,HBV DNA,HBsAg,HBeAg status,ALT,γ-GGT,Alb,UA,PLT,Neu,GPR,Forns,and APRI between CVR group and PVR group(P<0.05).Multivariate analysis showed that HBV DNA,HB sAg and ALT were independent influencing factors of PVR in CHB patients.The ROC curve analysis showed that all the independent influencing factors can predict the occurrence of PVR(All P<0.05).2.To illustrate the prediction performance of single factor for CHB patients with LLV,ROC curves were performed separately for each of independent factor,the results show that ALT、HBV DNA and HBsAg could predict the occurrence of PVR(All P<0.05).The predictive value of ALT for PVR was lower than that of HBV DNA(P<0.001)and HBsAg(P=0.021),and there was no significant difference in the predictive value of HBV DNA and HB sAg(P=0.394).3.Kinetic analysis showed that:The levels of HBsAg and HBV DNA in the PVR group were significantly higher than those in the CVR group during the treatment period(All P<0.05),ALT in PVR group was significantly lower than that in CVR group at baseline(P<0.05),but significantly higher than CVR group at week 12,24,36 and 48(All P<0.05).The decline of HB sAg and HBV DNA within 48 weeks in PVR group was higher than that in CVR group(both P<0.05)but the decline of ALT in 48 weeks was lower than that in CVR group(P<0.05).Conclusions:1.Even with long-term use of first-line NAs regimen,about 30%of CHB patients with initial treatment would still develop PVR.2.HBsAg,HBV DNA and ALT at baseline could predict the occurrence of PVR in CHB patients with initial NAs treatment.3.The baseline HBV DNA and HBsAg levels should be considered together when using the decline of HBV DNA and HBsAg to predict the virological response.Dynamic detection of HBsAg,HBV DNA and ALT changes is helpful to timely detect the poor response of CHB patients during NAs treatment.