慢性乙型肝炎低病毒血症患者HBV RNA的表达及临床意义OA

Objective To investigate the expression characteristics of serum HBV RNA in patients with low-level viremia(LLV)and its value in the diagnosis of LLV.Methods A total of 402 chronic hepatitis B(CHB)patients who attended Affiliated Hospital of Zunyi Medical University from December 2023 to May 2025 were enrolled,and according to their viral load,they were divided into complete virologic response(CVR)group(190 patients with HBV DNA<20 IU/mL)and LLV group(212 patients with an HBV DNA level of≥20 IU/mL and<2 000 IU/mL).The two groups were analyzed in terms of age,sex,disease type,serum HBV RNA,HBeAg,alanine aminotransferase(ALT),aspartate aminotransferase(AST),and total bilirubin(TBil),and according to HBeAg status,the patients in the LLV group were further divided into HBeAg-negative group with 140 patients and HBeAg-positive group with 72 patients.The chi-square test was used for comparison of categorical data between two groups,and the Mann-Whitney U test was used for comparison of continuous data between two groups.A multivariate Logistic regression analysis was used to investigate the influencing factors for LLV in CHB patients,and a Spearman's rank correlation analysis was used to analyze the correlation of HBV RNA with HBV DNA,ALT,AST,and TBil in the LLV group.The receiver operating characteristic(ROC)curve was plotted to evaluate the efficacy of HBV RNA in the diagnosis of LLV.Results Compared with the CVR group,the LLV group had a significantly higher serum level of HBV RNA[3(1—5)log10 copies/mL vs 2(1—3)log10 copies/mL,Z=-2.346,P=0.019]and a significantly higher proportion of patients with hepatitis B cirrhosis(31.13%vs 22.11%,χ2=4.155,P=0.042)or hepatocellular carcinoma(9.91%vs 4.74%,χ2=3.876,P=0.049).The multivariate Logistic regression analysis showed that HBV RNA(odds ratio=1.163,95%confidence interval:1.058—1.278,P=0.002)was an independent risk factor for the onset of LLV in CHB patients.Among the patients with LLV,HBeAg-positive patients had a significantly higher level of HBV RNA than HBeAg-negative patients[6(4—7)log10 copies/mL vs 2(1—3)log10 copies/mL,Z=-9.962,P<0.001].The correlation analysis showed that HBV RNA level had no significant correlation with HBV DNA,ALT,AST,or TBil in the patients with LLV(all P>0.05).The ROC curve analysis showed that HBV RNA had an AUC of 0.567 for the diagnosis of LLV(P=0.021),with an optimal cut-off value of 4.5 log10 copies/mL,a sensitivity of 30.7%,and a specificity of 85.8%.Conclusion Serum HBV RNA level is an independent risk factor for the development of LLV in CHB patients,and there is a significant increase in the expression of HBV RNA in HBeAg-positive patients.Therefore,it may serve as a potential biomarker for clinical risk assessment.