摘要目的 探讨乙型肝炎病毒(HBV)慢性感染者对e-抗原(HBeAg)阴性实验室相关指标定期监测的认知情况及影响因素,分析HBeAg阴转相关因素与转归.方法 选择济宁市传染病医院2015年1月至2017年3月治疗的HBV感染者302例,对HBV慢性感染者302例进行疾病相关认知问卷调查,通过单因素和多因素logistic回归分析定期监测行为的影响因素和HBeAg阴转影响因素;同时选择163例HBeAg阴性HBV感染者将其分成非定期监测和定期监测治疗两组,进行相关实验室项目水平和转归情况分析.结果 HBV慢性感染者的心理压力(OR=4.339,95％CI 1.322～14.243)、抗病毒治疗(OR=5.149,95％CI 1.628～16.283)、乙型肝炎知识了解程度(OR=3.306,95％CI 1.108～9.867)、病情稳定情况(OR=3.229,95％CI 1.094～9.528)是促进定期监测因素(均P<0.O5).抗病毒治疗(OR=0.298,95％CI 0.108～0.822)、病毒基因变异(OR=0.202,95％CI 0.048～0.856)、病程时间(OR=0.340,95％CI 0.122～0.949)是HBeAg阴转的影响因素(均P<0.05).HBeAg阴性感染者定期监测治疗组的血清丙氨酸氨基转氨酶(ALT)、白蛋白(ALB)、甲胎蛋白(AFP)、乙型肝炎病毒核酸(HBV-DNA)水平分别为(68±34)IU/L、(40±12)g/L、(23.0±5.9)μg/L、(2.0±1.3)copies/mL,均显著低于非定期监测组的(126±56)IU/L、(35±10)g/L、(78.0±12.8)μg/L、(3.9±1.7)copies/mL(t=2.323、2.097、2.109、2.234,均P<0.05).结论 HBeAg 阴性 HBV 慢性感染者是需监控和控制疾病进展的重点人群,定期实验室监测转归较好,应加强患者认知教育,提高疾病控制率.

abstractsObjective To investigate the cognition influencing factors of regular laboratory monitoring of HBeAg negative in chronic HBV infection,and analyze the related factors of HBeAg conversion. Methods From January 2015 to March 2017,a total of 302 chronic HBV infected patients in Jinin Infectious Disease Hospital were investigated with a questionnaire about disease related cognition. Single factor and multiple factors Logistic regression analysis was used to analyze the influencing factors of regular monitoring behavior and HBeAg conversion. At the same time,163 cases of HBeAg negative HBV infection were divided into the two groups: regular and irregular monitoring, and disease related laboratory tests and the outcomes were analyzed. Results Psychological pressure(OR = 4. 339, 95％ CI:1. 322 - 14. 243),antiviral treatment( OR = 5. 149,95％ CI:1. 628 - 16. 283),knowledge of hepatitis B (OR = 3. 306,95％ CI:1. 108 - 9. 867) and the stability of disease(OR = 3. 229,95％ CI:1. 094 - 9. 528) were the regular monitoring promoting factors(all P < 0. 05). Antiviral therapy(OR = 0. 298,95％ CI:0. 108 - 0. 822),virus gene mutation(OR = 0. 202,95％ CI:0. 048 - 0. 856),and duration of disease(OR = 0. 340,95％ CI:0. 122 - 0. 949) were related factors of HBeAg conversion(all P < 0. 05). The serum levels of ALT,ALB,AFP and HBV - DNA in the HBeAg negative regular monitoring group were (68 ± 34) IU/ L, (40 ± 12) g/ L, (23. 0 ± 5. 9) μg/ L, (2. 0 ± 1. 3)copies/ mL,respectively,which in the non - regular monitoring group were (126 ± 56) IU/ L,(35 ± 10) g/ L, (78. 0 ± 12. 8)μg/ L,(3. 9 ± 1. 7) copies/ mL,respectively,the differences were statistically significant (t = 2. 323, 2. 097,2. 109,2. 234,all P < 0. 05). Conclusion HBeAg negative patients is a key group to monitor and control disease progression. Regular laboratory monitoring is better. Medical staff should enhance patients' cognition education and improve disease control rate.