Clin Mol Hepatol. 2016 Dec;22(4):423-431. doi: 10.3350/cmh.2016.0069. Epub 2016 Dec 25.
New perspectives of biomarkers for the management of chronic hepatitis B.Lin CL1,2, Kao JH3,4,5,6. Author information
1Department of Gastroenterology, Renai branch, Taipei City Hospital, Taipei, Taiwan.
2Department of Psychology, National Chengchi University, Taipei, Taiwan.
3Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
5Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
6Department of Medical Research, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan.
AbstractWith recent advances in molecular and genomic investigations, the impact of hepatitis B viral and host factors on the progression of chronic HBV infection has been explored. For viral factors, hepatitis B viral load is a strong predictor for liver disease progression. Hepatitis B viral kinetics appear to be important for successful anti-viral therapy. Serum HBsAg level serves as a complementary marker to viral load for the prediction of HBV-related adverse outcomes in patients with low viral load. In those with low viral load, high serum HBsAg level is associated with higher risks of cirrhosis and HCC. Hepatitis B core-related antigen (HBcrAg) induces host immune responses, and the reduction of the HBcrAg level as well as the increment of total anti-HBc level are significantly associated with favorable outcomes. HBV genotypes (genotype C/D) and mutants (basal core promoter and deletion mutation in pre-S genes) are well known viral genetic markers to predict disease progression. For host factors, serum inflammatory biomarkers have been developed to evaluate the HBV-associated hepatic necroinflammation and fibrosis. Host single nucleotide polymorphism on sodium taurocholate cotransporting polypeptide (NTCP, an HBV entry receptor) may be associated with a decreased risk for cirrhosis and HCC. In conclusion, patients with chronic hepatitis B should be evaluated with relevant viral and host markers to identify those who are at a higher risk of liver disease progression and then receive timely antiviral therapy.
KEYWORDS: Chronic hepatitis B; HBV DNA; HBcrAg; HBsAg; Total anti-HBc
Serum HBsAg level serves as a complementary marker to viral load for the prediction of HBV-related adverse outcomes in patients with low viral load. In those with low viral load, high serum HBsAg level is associated with higher risks of cirrhosis and HCC. Hepatitis B core-related antigen (HBcrAg) induces host immune responses, and the reduction of the HBcrAg level as well as the increment of total anti-HBc level are significantly associated with favorable outcomes.
和病毒定量检测HBV-DNA定量一样，HBsAg定量可以作为病情发展轻重程度的一个指标。
对于HBVB-DNA定量低的病人来说，HBsAg定量越高，cirrhosis和HCC风险越大（新理论，可信吗？）
HBcRAg定量反映了病人免疫反应程度，若HBctAg定量降低伴随anti-HBC定量升高，对病情当然是好征兆。