| Objective：The purpose of this paper is to study the serum level of HBsAgin the natural history of chronic HBV infection change trend, theimportant role of the antiviral effect of prediction,the judgment ofprognosis and etc.Methods： Choose during April2009-October2013in the first hospitalof Jilin University Department clinical and hospitalized of295patientswith CHB, consistent with the2010version of the Chronic Hepatitis BPrevention Guide diagnostic criteria.(1)295CHB patients divided intoHBeAg positive group and HBeAg negative group, observation baseline serumlevel of HBsAg and HBV DNA quantitative correlation.(2) According to the2010edition of the Chronic Hepatitis B Prevention Guide, according tothe natural history of chronic HBV infection is divided into stage IT (56cases), IC (119cases), LR (31cases) and ENH (89cases), observe the levelof serum HBsAg in the nature of the changes in the course of the diseaseand chronic HBV infection with HBV DNA quantitative correlation.(3)295patients with CHB were divided into treatment group191cases and thetreatment group of104cases were followed up for4weeks,12weeks and24weeks and48weeks, observe the changes in serum HBsAg levels in bothgroups.(4) Receive antiviral treatment of191patients with CHB treatmentbased on12weeks when the serum level of HBsAg, HBeAg status, clinicalmedicine and genotype observation indexes such as groups, were observedin each group between the level of serum HBsAg antiviral treatment in theprocess of change and the antiviral effect of forecast and judge theprognosis of application value.Results：(1)The serum HBsAg quantitative and HBV DNA in baseline levels werepositively correlated, differences statistically significant (r=0.274, P<0.05), in HBeAg positive group more significant (r=0.195, P<0.01).(2)In the natural history of chronic HBV infection in different periods,different level of serum HBsAg. Stage IT, IC, ENH period, period of LRHBsAg levels showed a trend of gradual decline, and between the four groupsand comparing two baseline level of HBsAg were statistically significant(P<0.05).In addition, the stage of IC and ENH level of HBsAg and HBV DNAration in baseline levels were positively correlated (r=0.179, P<0.05andr=0.05, P<0.05).(3)The treatment group was significantly lower level of serum HBsAgtrend,4weeks with baseline is no statistical significance (P>0.05),12weeks and24weeks and48weeks compared with baseline had statisticalsignificance (P<0.05);The treatment group in the level of serum HBsAg werefollowed up for4weeks,12weeks and24weeks has no obvious changes,compared with the baseline level has no statistical significance(P>0.05),at48weeks HBsAg level is on the rise, statistical differencescompared with baseline (P<0.05).HBsAg levels in treatment group andnon-treatment group48weeks had statistical significance (P<0.05).(4)In HBeAg positive patients to treatment at24weeks of serum HBsAg2.78log10IU/mL (606IU/mL) for the boundary value, the value of hisforecast48weeks complete response, best and HBsAg levels in theprediction of efficacy of the HBV DNA quantitative value higher (AuC=0.854, P=0.000).(5)In HBeAg negative patients to treatment to24weeks of HBsAg2.79log10IU/mL (620IU/mL) for the boundary value, its prediction to48weeksfor48weeks when the value of complete response, best and HBsAg levelsin the prediction of efficacy of the HBV DNA quantitative value higher(AuC=0.681, P=0.033).(6)PEG IFN and NUS in the two groups, the longitudinal comparison withbaseline treatment of4weeks is no statistical significance (P>0.05);12, 24and48weeks of treatment, two groups of serum HBsAg levels aredeclining, and the comparison with the baseline had statisticalsignificance (P<0.05).Transverse comparison, treatment of4weeks,12weeks when two groups of HBsAg level no statistical difference (P>0.05);inthe treatment of24weeks, two groups of serum HBsAg levels were comparedbaseline levels dropped1.06log10IU/mL,0.52log10IU/mL; At48weeks down1.24log10IU/mL,0.81log10IU/mL compared with baseline, HBsAg levelsdecreased significantly after treatment with interferon and compare thedifferences were statistically significant (P<0.05).(7)PEG-IFN treatment, HBsAg≦1500IU/mL group24weeks and48weekscomplete response rates were significantly higher than that of1500-20000IU/mL group and≧20000IU/mL group, and had statisticalsignificance(P<0.05);At48weeks compared with treatmentsignificantly(P<0.01);Longitudinal comparison, HBsAg levels during the1500-20000IU/mL and≧20000IU/mL group therapy at24weeks and48weekscomplete response rate is no statistical significance(P>0.05).Horizontal comparison, as the treatment prolonged, HBsAg≦1500IU/mL group24weeks complete response rate compared with48weekswas statistically significant (P<0.05), while the HBsAg quantitative in1500-20000IU/mL and≧20000IU/mL group at24weeks and48weeks completeresponse rate has no obvious changes, is no statistical significance(P>0.05).(8)NUS therapy,24weeks complete response rate in HBsAg≦1500IU/mLgroup is higher than the1500-20000IU/mL and≧20000IU/mL group, but onlymeaningful compared with≧20000IU/mL group (P<0.05), compared with1500-20000IU/mL group insignificant (P>0.05);48weeks complete responserate of HBsAg≦1500IU/mL group is significantly higher than in1500-20000IU/mL group and≧20000IU/mL group, and had statistical significance (P<0.05) with prolonged treatment, the three groups of48weeks complete response rate than24weeks was increased, but is no statisticalsignificance (P>0.05).(9)NUS treatment group after treatment, the serum level of HBsAg is onthe decline, including LAM, LDT, ETV group treatment of4weeks,12weeksand24weeks,48weeks compared with baseline had statistical significance(P<0.05); ADV treatment group at4weeks,12weeks compared with thebaseline level of serum HBsAg has no statistical significance (P>0.05),24and48weeks treatment with baseline comparison have statisticalsignificance (P<0.05).(10)NUS treatment process, the group B genotypes HBsAg levels dropsignificantly, HBsAg levels during4weeks compared with baseline nostatistical significance (P>0.05),12weeks and24weeks and48weeks HBsAglevels and baseline differences were statistically significant(P<0.05);C genotype in the treatment of4weeks,12weeks HBsAg levels andbaseline no statistical significance (P>0.05), treatment with baselinelevels24and48weeks difference was statistically significant(P<0.05),the treatment of48weeks, B genotypes in patients with HBsAg levels down0.86log10IU/mL compared with the baseline, C genotype fell0.81log10IU/mL,the difference was statistically significant(P<0.05).Conclusion：1. Serum HBsAg and HBV DNA levels at baseline quantitative consistency.2. The natural history of chronic HBV infection in patients with chronichepatitis b at different stages of serum HBsAg levels, different from theimmune tolerance period, immune clearance period, low activity toreplicate a downward trend.3. Monitoring change of serum HBsAg levels can predict curative effectand prognosis.4. Monitoring of serum HBsAg levels are helpful to guide the clinicalmedication. 5. Application of antiviral NUS in the treatment process, the genotypeB patients with CHB patients have higher levels of serum HBsAg C genotypedown earlier and more prominent. |
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