血清BAFF预测聚乙二醇干扰素-α治疗非活动性HBsAg携带者临床治愈的效能分析*

目的 探讨血清B细胞活化因子(BAFF)预测聚乙二醇干扰素-α(Peg-IFN-α)治疗非活动性HBsAg携带者(IHCs)临床治愈的效能。方法 2018年1月～2020年8月我院诊治的IHCs 54例,给予Peg-IFN-α治疗48 w,再随访24 w。采用ELISA法检测血清BAFF,应用Logistic回归分析影响临床治愈的因素,应用受试者工作特征曲线(ROC)及其曲线下面积(AUC)评价血清BAFF预测临床治愈的效能。结果 在72 w末,24例(44.4%)患者获得临床治愈,30例未获得临床治愈;治愈组与未治愈组基线血清BAFF水平分别为(670.9±105.9)pg/mL和(612.7±183.8)pg/mL,差异无统计学意义(P>0.05);在治疗12 w和24 w时,治愈组血清BAFF水平分别为(805.8±197.6)pg/mL和(895.3±227.4)pg/mL,显著高于未治愈组【分别为(675.3±190.8)pg/mL和(724.4±218.0)pg/mL,P 均<0.05】;多因素Logistic回归分析显示基线HBsAg定量、HBV DNA<20 IU/mL、治疗12 w和24 w时血清BAFF水平是影响临床治愈的独立因素;ROC分析显示,以Peg-IFN-α治疗12 w时血清BAFF水平大于704.3 pg/mL为截断点,其预测治疗应答的AUC=0.722, 敏感度为79.2%,特异度为66.7%,以24 w时血清BAFF水平大于741.9 pg/mL为截断点,其预测治疗应答的AUC=0.725,敏感度为75.0%,特异度为70.0%。结论 应用Peg-IFN-α治疗IHCs可获得约40%的应答率,在治疗过程中监测血清BAFF水平逐渐升高的患者可能获得满意的治疗结果。

Serum B-cell activating factor levels in predicting antiviral response of pegylated interferon alpha in inactive HBsAg carriers

Objective The aim of this study was to investigate serum B-cell activating factor (BAFF) levels in predicting antiviral response of pegylated interferon alpha (Peg-IFN-α) in inactive HBsAg carriers(IHCs). Methods 54 IHCs were recruited in our hospital between January 2018 and August 2020,and all were treated with Peg-IFN-α for 48 weeks and followed-up for 24 weeks. Serum BAFF levels were measured by ELISA. The Logistic regression analysis was applied to analyze the factors affecting antiviral response, and the area under the receiver-operating characteristic curve (AUC) were applied to evaluate the performance of serum BAFF levels in predicting antiviral response. Results At the end of 72 weeks, the complete response (CR) was obtained in 24 cases (44.4%), and were not obtained in 30 cases (55.6%); there was no significant difference as respect to baseline serum BAFF levels (670.9±105.9) pg/mL vs. (612.7±183.8)pg/mL, P>0.05] between the two groups; at the end of 12 weeks and 24 weeks, serum BAFF levels in responders were (805.8±197.6)pg/mL and (895.3±227.4)pg/mL, both significantly higher than (675.3±190.8)pg/mL and (724.4±218.0)pg/mL, respectively, P<0.05] in non-responders; the multivariate Logistic regression analysis showed that baseline serum HBsAg, HBV DNA<20 IU/mL, serum BAFF levels at week 12 and week 24 were the independent factors impacting the antiviral response; the ROC analysis demonstrated that the AUC=0.722, with the sensitivity (Se) of 79.2% and specificity (Sp) of 66.7%, when serum BAFF level greater than 704.3 pg/mL at week 12 was set as the cut-off-value, and the AUC=0.725, with Se of 75.0% and Sp of 70.0%, when serum BAFF level greater than 741.9 pg/mL at week 24 was set as the cut-off-value in predicting antiviral response in patients receiving Peg-IFN-α treatment. Conclusion The CR is nearly 40% in IHCs receiving Peg-IFN-α treatment, and the surveillance of serum BAFF levels might guide the regimen going or stopping.