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标题: AASLD 2013:预测在接受恩替治疗患者的血清HBsAg下降 [打印本页]

作者: StephenW 时间: 2013-10-8 17:13 标题: AASLD 2013:预测在接受恩替治疗患者的血清HBsAg下降

TITLE: Predictors of Serum HBsAg Decline in Chronic Hepatitis B Patients Undergoing Entecavir Therapy

AUTHORS (FIRST NAME, LAST NAME): Hsueh-Chou Lai1, 2, Cheng-Yuan Peng1, 4, Wen-Pang Su1, Chia-Hsin Lin1, Po-Heng Chuang1, Jon-Ta Kao1, 4, Sheng-Hung Chen1, 3
Institutional Author(s):
INSTITUTIONS (ALL): 1. Division of Hepato-gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
2. School of Chinese Medicine and Graduate Institute of Clinical Medical Science, China Medical University , Taichung, Taiwan.
3. Graduate Institute of Clinical Medical Science, China Medical University , Taichung, Taiwan.
4. School of Medicine , China Medical University , Taichung, Taiwan.
ABSTRACT BODY: Background: The decline in quantitative serum hepatitis B surface antigen (qHBsAg) level and its predictors in chronic hepatitis B (CHB) patients undergoing long-term entecavir (ETV) therapy remain unclear. Patients and Methods: Three hundred and sixty-one treatment-naïve (321 compensated and 40 acutely decompensated) CHB patients had been treated with ETV for at least 1 year. Serum HBsAg and HBV DNA levels were measured with the Abbott Architect HBsAg QT assay and the Cobas Amplicor HBV Monitor Test throughout treatment, respectively. Results: The baseline features were: median age: 49 years, 75.3% men, 37.9% HBeAg-positive (N=137), 59.2% genotype B infection, median ALT: 87 IU/L, HBV DNA: 6.56 log10copies/mL, and qHBsAg: 3.3 log10IU/mL. Among them, 249, 186 and 94 patients had received ETV therapy for ≧3, 4 and 5 years, respectively (mean duration: 46.5±14.6 months (M)). At 3 and 12M of therapy, 25.6% (HBeAg-positive: 38.4% vs -negative: 17.7%) and 30.8% (HBeAg-positive:40.8% vs -negative: 24.9%) of patients had qHBsAg decline from baseline of ≧50%, respectively. For HBeAg-positive patients, there were significant declines in qHBsAg level between baseline and 3M, 12 and 24M (P=0.0281), and 36 and 48M (P=0.0116). For HBeAg-negative patients, there were significant declines in qHBsAg level between baseline and 3M, 6 and 12M,12 and 24M, 24 and 36M, and 36 and 48M (all P<0.05). Patients were categorized in three subgroups according to the pattern of qHBsAg decline from baseline:≧50% at 3M, ≧50% at 12M, and <50% at 12M. For HBeAg-positive patients, the subgroup with qHBsAg decline from baseline of ≧50% at 3M of therapy had significantly lower qHBsAg levels than the other two subgroups up to 3 years of treatment. Multivariate logistic regression analyses identified genotype B (OR=2.572, P=0.0460), ALT ≧120 IU/L (OR=9.295, P<0.0001) and baseline qHBsAg ≧5000 IU/mL (OR=3.795, P=0.0045) as predictors of qHBsAg decline from baseline of ≧50% at 3M of therapy. For HBeAg-negative patients, the qHBsAg levels between the subgroups with qHBsAg decline from baseline of ≧50% at 3 or 12M of therapy were similar but was significantly lower than the subgroup with qHBsAg decline from baseline of <50% at 12M of therapy. Multivariate logistic regression analyses identified ALT ≧120 IU/L (OR=8.255, P<0.0001) and baseline qHBsAg ≧5000 log10 IU/mL (OR=6.311, P<0.0001) as predictors of qHBsAg decline from baseline of ≧50% at 12M of therapy. Conclusion: Higher baseline serum qHBsAg and ALT levels are predictors of qHBsAg decline from baseline of ≧50% for both HBeAg-positive and -negative patients undergoing ETV therapy.

作者: StephenW 时间: 2013-10-8 17:14

背景：定量血清中乙肝表面抗原水平（ qHBsAg ）和其预测慢性乙型肝炎（ CHB ）患者接受恩替卡韦（ ETV ）长期治疗的跌幅仍不清楚。病人与方法：三百61治疗初治（321补偿和40急性失代偿） CHB患者恩替卡韦治疗至少1年。测定血清HBsAg和HBV DNA水平与雅培Architect HBsAg的QT检测和COBAS AMPLICOR HBV显示器测试整个治疗过程中，分别。结果：基线特征为：平均年龄：49岁，男性占75.3 ％， 37.9％， HBeAg阳性（ N = 137 ），59.2 ％的B基因型感染， ALT中位数：87 IU / L， HBV-DNA ：6.56 log10copies/mL qHBsAg ： 3.3 log10IU/mL 。其中， 249， 186和94例患者接受ETV治疗≧3 ， 4年和5年，分别为（平均病程46.5 ±14.6个月（ M ））。 3和12个月的治疗，25.6％（ HBeAg阳性： 38.4％和负17.7％）和30.8 ％（ HBeAg阳性：40.8 ％和负24.9％）的患者从基线下降≧ 50 qHBsAg ％之间。对于HBeAg阳性患者，有基线和3M ， 12和24M（ P = 0.0281 ）， 36和48M （P = 0.0116 ）之间qHBsAg水平的显着下降。对于HBeAg阴性患者，有显着下降之间qHBsAg水平基线和3M ， 6和12个月， 12和24M ， 24和36M， 36和48M （均P < 0.05 ）。下降，从基线的格局qHBsAg病人被分为三个小组： ≧50 ％， 3M ， 12M ≧50 ％，和12个月的50％。对于HBeAg阳性患者， 3M治疗qHBsAg从基线下降≥ 50 ％的亚组有显着降低qHBsAg水平比其他两个亚组长达3年的治疗。多因素Logistic回归分析发现B基因型（ OR = 2.572 ，P = 0.0460 ）， ALT ≧120 IU / L （ OR = 9.295 ，P <0.0001）和基线qHBsAg ≧ 5000 IU /毫升（ OR = 3.795 ，P = 0.0045 ） 3M治疗qHBsAg从基线下降≥ 50 ％的预测。对于HBeAg阴性患者， 3或12M的治疗qHBsAg从基线下降≥ 50 ％的亚组之间的的qHBsAg水平相似，但比治疗12M <50％，从基线下降qHBsAg亚组显著下降。多因素Logistic回归分析确定ALT ≧120 IU / L （ OR = 8.255 ， P <0.0001）和基线qHBsAg ≧ 5000 log10的国际单位/毫升（ OR = 6.311 ，P <0.0001 ）作为预测的qHBsAg ≧50 ％，从基线下降12个月的治疗。结论：基线血清qHBsAg和ALT水平的预测qHBsAg接受ETV治疗HBeAg阳性和阴性患者从基线下降≥ 50 ％。

作者: 王震宇 时间: 2013-10-12 03:44

你先告诉我，你自己读明白了么？

好吧！你继续运你的宝贝垃圾吧！看来你也只能干点这些活儿了。

作者: 大海潮水 时间: 2013-10-12 07:52

恩替能使表面抗原值下降50%?

作者: StephenW 时间: 2013-10-12 15:17

本帖最后由 StephenW 于 2013-10-12 15:17 编辑

回复大海潮水的帖子

是。但并不是每个人, 也不是50%每隔几个月.
结果是非常复杂,混合的. 降幅, 下降速度, 人到人不同，不同的病毒基因型不同结果.
请阅读以下.

作者: StephenW 时间: 2013-10-12 15:18

[tr][/tr]

TITLE: Quantitative Hepatitis B Surface Antigen Kinetics In Entecavir Treated Patients

AUTHORS (FIRST NAME, LAST NAME): Ju Yeon Cho1, Yong Han Paik1, Won Sohn1, Seon Woo Kim2, Sook Young Woo2, Geum-Youn Gwak1, Moon Seok Choi1, Joon Hyeok Lee1, Kwang Cheol Koh1, Seung Woon Paik1, Byung Chul Yoo1

Institutional Author(s):

INSTITUTIONS (ALL): 1. Medicine, Samsung Medical Center, Seoul, Korea, Republic of.
2. Biostatistics, Samsung Medical Center, Seoul, Korea, Republic of.

ABSTRACT BODY: Background: Hepatitis B surface antigen (HBsAg) loss is associated with immunological control of the hepatitis B virus and durable suppression of viral replication. HBsAg levels reflect transcription of closed covalent circular DNA in patients with chronic hepatitis B (CHB). The aim of this study was to investigate the on-treatment kinetics of quantitative HBsAg during entecavir therapy to predict the treatment period needed to achieve HBsAg seroconversion.

Methods: From a cohort of 1006 CHB treatment-naïve patients who were started on entecavir, 425 patients with a quantitative HBsAg value after initiation of entecavir were selected. Among the patients, 321 patients (75.1%) had more than 2 serial samples. The kinetics of quantitative HBsAg decline was assessed using 1465 samples from 413 patients with normal distribution and homoscedasticity with mixed linear model to predict the time to clear HBsAg while on entecavir treatment.

Results: Among the 413 patients, 213 patients (51.6%) were HBeAg positive and 200 patients (48.4%) were HBeAg negative. At baseline, the age of the HBeAg(-) group was significantly older (p < 0.001) and the level of HBV-DNA was significantly lower (p < 0.001) compared to the HBeAg (+) group. During a median follow up of 49.5 months, the quantitative HBsAg level showed a slow but consistent decrease in value regardless of the HBeAg status. The HBeAg-positive group had a mean slope of -0.0036 ± 0.0003 Log10 IU/month (p<0.001) and the HBeAg-negative group had a mean slope of -0.0037 ± 0.0004 Log10 IU/month (p<0.001). The calculated time to clear quantitative HBsAg in HBeAg-positive and HBeAg-negative groups were 87 years and 73 years, respectively.

Conclusions: Analysis of the kinetics for HBsAg level during entecavir therapy suggests the treatment period required to achieve quantitative HBsAg clearance during entecavir therapy is life-long, regardless of the HBeAg status of chronic hepatitis B patients.

(No Table Selected)

Co-Author Disclosure Status

The following authors have completed their AASLD 2013 disclosure: Ju Yeon Cho: Disclosure completed | Yong Han Paik: Disclosure completed | Won Sohn: Disclosure completed | Seon Woo Kim: No Answer. | Sook Young Woo: No Answer. | Geum-Youn Gwak: Disclosure completed | Moon Seok Choi: Disclosure completed | Joon Hyeok Lee: Disclosure completed | Kwang Cheol Koh: No Answer. | Seung Woon Paik: Disclosure completed | Byung Chul Yoo: Disclosure completed

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作者: StephenW 时间: 2013-10-12 15:19

背景：乙型肝炎表面抗原（HBsAg）损失是与B型肝炎病毒和持久抑制病毒复制的免疫控制。 HBsAg水平反映慢性乙型肝炎（ CHB ）患者共价闭合环状DNA的转录。这项研究的目的是探讨治疗恩替卡韦治疗过程中HBsAg定量动力学预测治疗期间需要达到乙肝表面抗原血清学转换。

方法：从1006慢性乙肝初治患者恩替卡韦开始队列， 425例患者用恩替卡韦开始后的HBsAg定量值。在患者中， 321例（ 75.1％）有超过2个串行样本。 HBsAg定量下降的动力学评估采用1465样本正态分布和方差齐性与混合线性模型预测的时间来清除乙肝表面抗原，而恩替卡韦治疗413例。

结果：在413例患者中， 213例（51.6％） HBeAg阳性200例（48.4％）为HBeAg阴性。在基线，年龄的HBeAg （ - ）组显着老年人（ P <0.001 ）和HBV - DNA水平显着降低（ P < 0.001 ）的HBeAg （+）组相比。中位随访49.5个月期间， HBsAg定量水平呈缓慢但持续下降值，而不管HBeAg状态。 HBeAg阳性组的平均坡度为-0.0036 ± 0.0003 log10的IU /月（ P <0.001 ）和HBeAg阴性组平均坡度为-0.0037 ± 0.0004 LOG10 IU /月（ P < 0.001 ）。清除HBsAg定量HBeAg阳性和HBeAg阴性组的计算时间分别为87岁和73岁，分别。

结论：恩替卡韦治疗期间HBsAg水平的动力学分析表明治疗期间，需要实现定量HBsAg清除恩替卡韦治疗期间是终身的，慢性乙型肝炎患者HBeAg状态无关。

作者: StephenW 时间: 2013-10-12 15:55

本帖最后由 StephenW 于 2013-10-12 15:56 编辑

回复王震宇的帖子

如果你一直在使用标准的HBsAg定量检测（不是半定量，人工稀释，COI）,专业和科学的方法，和更长的随访期间, 你会看到和并报道了类似结果.

如果你继续你的业余方式, 看来你也只能干点这些活儿了.

作者: 王震宇 时间: 2013-10-12 16:34

哈哈哈，我用 IU已经三年了，但IU也不能彻底离开手工干预。至少10-15%那部分超过52000 IU的

你是专业，嘿嘿！专业的垃圾搬运工

作者: StephenW 时间: 2013-10-12 17:58

本帖最后由 StephenW 于 2013-10-12 18:01 编辑

回复王震宇的帖子

纠正错误，有进步.多来这里学习.

作者: 王震宇 时间: 2013-10-12 23:42

“你我是两条道上跑的车，走的不是一条路哇”
“我是不会叫你满意的！”
“那些个东西，我早就领教过啦”

摘自现代京剧《红灯记》第六场赴：宴斗鸠山

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