Study On Early Predictive Factors Of An Incomplete Viral Response With 48 Week-Entecavir Therapy In HBeAg-Positive Chronic Hepatitis B Patients

Objective: To study the virological and serological indicators before treatment and 24 weeks after treatment to predict the partial virological response(PVR)of 48-week entecavir(ETV)treatment,and formulate early clinical adjustment treatment plans for HBeAg-positive CHB patients.Methods: 1.HBeAg-positive CHB-na(?)ve patients diagnosed in the Department of Infectious Diseases,Shengjing Hospital,China Medical University,who were treated with oral ETV monotherapy from January 2018 were enrolled.2.The groups were divided according to the test results of HBV DNA at 48 weeks.Among them,HBV DNA < 20IU/ml was the complete viral response(CVR)group,and HBV DNA ≥ 20IU/ml was the PVR group.3.The virological and serological indexes of the two groups before treatment and 24 weeks after treatment were compared.Receiver operating characteristic(ROC)curve univariate analysis and multivariate logistic regression were performed to find out the early predictors of PVR in HBeAg-positive CHB patients receiving ETV therapy for48 weeks.4.SPSS25.0 software and Medcalc software were used to analyze the data,and Graph Pad Prism8 software was used to draw charts.The data of measurement data in accordance with normal distribution and homogeneity of variance were expressed by mean±standard deviation(± s)and compared by t-test,while the data of non-normal distribution were expressed by [median(P25 ～ P75)] and compared by Mann-Whitney U test,and classified variables were expressed by cases and percentage,and chi-square test was used to compare,The difference was statistically significant.Univariate analysis was performed on the(ROC)curve,and Logistic regression model(backward method)was used for multi-factor prediction analysis.P< 0.05 was considered as statistically significant.Results: As of July 2020,a total of 90 cases had completed 48 weeks of treatment,including 50 cases of CVR(55.56%)and 40 cases of PVR(44.44%).Before treatment and at 24 weeks of treatment,HBs Ag,HBeAg and HBV DNA in the PVR group were significantly higher than those in the CVR group(P < 0.001).Univariate analysis showed that HBV DNA quantification(AUC = 0.961,P < 0.001,PPV = 97.06%,NPV = 87.50%)and HBeAg quantification(AUC = 0.883,P < 0.001,PPV = 90.63%,NPV = 81.03%)had higher predictive value at 24 weeks of treatment.Multivariate analysis showed that HBeAg > 1.952 log10 S/CO(OR = 3.177,95% CI : 1.261 ～8.267,P = 0.018)and HBV DNA > 2.205 log10 IU / ml(OR = 43.197,95% CI :6.858 ～ 272.069,P < 0.001)were independent predictors of PVR at 24 weeks of treatment,and their combination had the best predictive effect.Conclusion:1.In HBeAg-positive CHB patients receiving ETV treatment for 48 weeks,HBV DNA combined with HBeAg quantification can be an early predictor of PVR at 24 weeks.2.Additionally,patients with both HBV DNA and HBeAg > 2log10 at 24 weeks of treatment must wait 48 weeks to obtain CVR,so it is recommended that treatment strategies should be adjusted at this time.