Study On The Relationship Between The Novel HBV Markers And Chronic HBV Infection

Objective:To explore the levels of serum HBV RNA and HBcrAg in different clinical stages of chronic HBV infection treated with NA drugs,and to distinguish the different clinical stages of CHB stage IV and chronic HBV infection by using decision tree model and line chart model combined with other common clinical indexes,to provide a new basis for the application of serum HBV RNA and HBcrAg in the evaluation of chronic HBV infection and monitoring of drug resistance mutations.Methods:（1）A total of 189 patients who had not received treatment within one year were divided into CHB stages.The distribution of HBV RNA and HBcrAg in the CHB4phase was described by inter-group comparison,the relationship between HBV RNA and HBcrAg and conventional indexes was described by correlation analysis,and the ability of HBV RNA and HBcrAg to distinguish the CHB 4 phase was described by decision tree model.（2）Two hundred and twenty-five patients undergoing NA treatment were divided into groups according to different clinical stages of chronic hepatitis B（chronic hepatitis B,CHB）（CHB=159,LC=42,HCC=24）.The distribution characteristics of HBV RNA and HBcrAg in different clinical stages after HBV infection were compared between groups,the relationship between HBV RNA and HBcrAg and routine indexes was described by correlation analysis,and HBV RNA and HBcrAg were described by line chart model to distinguish different clinical stages of NA treatment.Results:（1）For chronic HBV infection in IT,IC,ENQ and ENH 4 groups,there were significant differences in HBV RNA concentration among the four stages of CHB infection（except IT stage and IC stage）.The distribution of HBcrAg level in four periods was similar to that of HBV RNA.The correlation between HBV RNA,HBcrAg and HBV DNA was different among the four groups.The decision tree model showed that the AUROC curve value of HBV RNA and HBcrAg to distinguish ENQ and ENH was 0.836,while the accuracy,sensitivity and specificity of HBcrAg combined with ALT to identify CHB staging were95.65%,95.83%and 95.55%,respectively.（2）For HBV patients in different clinical stages（CHB,LC and HCC）treated with NA,the serum HBV RNA level in the CHB group（3.42）log₁₀copies/m L was significantly higher than that in the LC group（2.00-2.62）log₁₀copies/m L and HCC group（2.00-2.87）log₁₀copies/m L.The level of HBcrAg showed a similar phenomenon.The correlation analysis of serological indexes was carried out in CHB,LC and HCC groups.The results showed that HBV RNA and HBcrAg in the CHB group were positively correlated with the HBV DNA level.However,there was no significant correlation among HBV RNA,HBcrAg and HBV DNA in the LC group and HCC group.The establishment of a line chart model based on age,Log AFP,HBV RNA and HBcrAg can effectively distinguish the different clinical stages of HBV infection in patients treated with NA,and the C index is 0.867.Conclusions:（1）Serum HBV RNA and HBcrAg concentrations are different in untreated chronic HBV-infected patients with the different natural courses of CHB disease and different clinical stages of HBV-infected patients treated with NA.（2）HBV RNA and HBcrAg are related to HBV DNA in the state of HBe Ag（+）and HBe Ag（-）,but their correlation with HBV DNA is different in different periods.（3）Serum HBV RNA and HBcrAg can be used as virological indicators to evaluate liver inflammation in patients with serum HBe Ag（-）,and combined with other clinical indicators can accurately distinguish the CHB stage.Serum HBV RNA and HBcrAg can also be used to evaluate the antiviral efficacy of patients receiving continuous NA treatment and to monitor drug resistance mutations for a long time to effectively distinguish the clinical stages of patients receiving drug treatment after chronic HBV infection,thus helping clinicians to provide individualized management and treatment strategies for patients.