Analysis Of HBV RNA And QAnti-HBc In Chronic Hepatitis B Virus-infected Patients At Different Stages

Background:Chronic hepatitis B virus infection remains a global health problem,and persistent viral replication accelerates disease progression,making the active search for serum markers reflecting the status of intrahepatic viral activity a research priority.Currently,the serum markers commonly used to monitor hepatitis B virus（HBV）in clinical practice are hepatitis B virus surface antigen（HBs Ag）,hepatitis B virus e antigen（HBe Ag）,and hepatitis B virus deoxyribonucleic acid（HBV DNA）.Studies on hepatitis B virus ribonucleic acid（HBV RNA）and hepatitis B virus core antibody（Anti-HBc）in serum have gradually received attention in recent years,but the trends of HBV RNA and q Anti-HBc at different stages of HBV infection and the correlation with traditional HBV serum markers have been less reported.Purpose:In this study,we analyzed the trends of serum HBV RNA and Anti-HBc at different stages of chronic HBV infection and their correlation with traditional HBV serum markers,and evaluated whether HBV RNA could be used as a marker for chronic HBV infection stages.Methods:This study included 200 untreated chronic HBV-infected patients who visited the outpatient or inpatient department of hepatobiliary and pancreatic medicine at the First Hospital of Jilin University from June 2021 to February 2022.gender,age,time of hepatitis B diagnosis,type of previous or current antiviral drug application and duration information,clinical data and virological indexes,serum specimens were collected.q Anti-HBc was detected using the test kits from Shanghai Rendu Co.Detection of HBV RNA quantitative,Suzhou Xinbo Biotechnology’s hepatitis B virus core antibody test kit for q Anti-HBc.according to the 2017 European Society of Hepatology clinical practice guidelines:management of HBV infection,they were divided into 4 phases:HBe Ag-positive infection phase,HBe Ag-positive hepatitis phase,HBe Ag-negative infection phase,and HBe Ag-negative hepatitis phase.The basic characteristics,virological and biochemical indices between groups were analyzed,the relationship between HBV RNA,Anti-HBc and other serum markers was assessed by Spearman’s correlation coefficient,the working characteristic curves of subjects were drawn to determine the predictive characteristics of HBV RNA for different stages,and the Youden index was determined by the maximum value of sensitivity plus specificity to determine the cut-off value level.Results:1.A total of 200 patients with chronic hepatitis B were included,including 84HBe Ag-positive patients and 116 HBe Ag-negative patients slightly more males（52.5%）than females,with a mean age of 42±11 years.2.Within the HBe Ag positive group,the median q Anti-HBc was 2.43log₁₀IU/m L in the infected group and 3.36log₁₀IU/m L in the hepatitis group,with significant differences（P=0.028）,and no statistically significant differences（P>0.05）between the infected and hepatitis groups in the negative group.3.HBV RNA levels were significantly higher in HBe Ag-positive patients than in HBe Ag-negative patients.The median HBV RNA quantification in the HBe Ag-positive infection group,HBe Ag-positive hepatitis group,HBe Ag-negative infection group,and HBe Ag-negative hepatitis group were 5.21,6.48,1.7,and 2.59 log₁₀copies/m L,respectively,except for the difference between the HBe Ag-positive infection group and the hepatitis group,which was not statistically significant,and the difference between the two comparison groups all of them were statistically significant（P<0.05）.4.The overall serum HBV RNA was strongly correlated with HBV DNA quantification（r=0.823,P<0.001）,and this correlation was not affected by HBe Ag status.HBV RNA was moderately correlated with HBs Ag（r=0.550,P<0.001）,strongly correlated in the HBe Ag-positive group（r=0.736,P<0.001）and in the HBe Ag-negative group（r=0.262,P=0.005）,which was strongly influenced by HBe Ag status.5.In overall chronic hepatitis B patients,serum q Anti-HBc correlated with HBV DNA only（r=0.200,P=0.005）,showed weak correlation with q Anti-HBc and HBs Ag within the HBe Ag positive group（r=-0.281,P=0.021）,and showed weak correlation with HBV DNA and HBV RNA in the HBe Ag negative correlation（r=0.383 P<0.001,r=0.302P=0.001）.6.The subject working characteristic curve showed that HBV RNA levels>4.12log₁₀copies/m L were highly suggestive of HBe Ag positive patients,at which point the AUROC was 0.897,and the sensitivity,specificity,positive predictive value and negative predictive value were 76.2%,94.8%,91.4%and 84.6%,respectively.Within the HBe Ag-positive group,HBV RNA>4.32log₁₀copies/m L combined with Anti-HBc>3.15log₁₀IU/m L had a reference value for suggesting HBe Ag hepatitis group.Within the HBe Ag negative group,HBV RNA>2.56log₁₀copies/m L combined with HBV DNA>3.41log₁₀IU/m L has a reference value for suggesting HBe Ag hepatitis group.Conclusions:1.The quantitative values of HBV RNA vary at different stages after chronic hepatitis B infection,and the lowest levels exist during the HBe Ag-negative infection period.2.HBV RNA is closely correlated with HBV DNA regardless of the status of HBe Ag.And HBV RNA showed moderate correlation with HBs Ag and was greatly influenced by the status of HBe Ag.3.Anti-HBc was weakly correlated with HBV DNA in the overall and HBe Ag negative groups,and only weakly correlated with HBs Ag within the positive group,and also weakly correlated with HBV RNA within the HBe Ag negative group.4.HBV RNA>4.12log₁₀copies/m L can be highly suggestive of HBe Ag positive patients.Within the HBe Ag-positive group,HBV RNA combined with Anti-HBc can distinguish the infection group from the hepatitis group.Within the HBe Ag-negative group,HBV RNA combined with HBV DNA has important reference value to distinguish the infection group from the hepatitis group.