World J Gastroenterol. 2018 Feb 14;24(6):725-736. doi: 10.3748/wjg.v24.i6.725.
Clinical utility of hepatitis B surface antigen kinetics in treatment-naïve chronic hepatitis B patients during long-term entecavir therapy.Lin TC1, Chiu YC1, Chiu HC1, Liu WC2, Cheng PN1, Chen CY1, Chang TT1, Wu IC3. Author information 1Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, 70403, Taiwan.2Infectious Disease and Signaling Research Center, National Cheng Kung University, Tainan 70403, Taiwan.3Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, 70403, Taiwan. [email protected].
AbstractAIM: To investigate the utility of hepatitis B surface antigen (HBsAg) kinetics in chronic hepatitis B patients during long-term entecavir treatment.
METHODS: This retrospective study included treatment-naïve chronic hepatitis B patients who received at least 2 years of consecutive entecavir treatment. Patients were followed up at three to six month intervals with liver biochemistry, hepatitis B virus DNA, and abdominal sonography. In hepatitis B e antigen (HBeAg)-positive patients, HBeAg levels were assessed every three to six month until results became negative. Serum HBsAg levels were determined at the baseline, one-year and five-year time points. Liver cirrhosis was diagnosed through liver biopsy, imaging examinations, or clinical findings of portal hypertension. Hepatocellular carcinoma was diagnosed by histological examination or dynamic image studies.
RESULTS: A total of 211 patients were enrolled. The median treatment time was 5.24 (2.00-9.62) years. Multivariate analysis showed that lower baseline HBsAg levels were associated with an earlier virological response, earlier hepatitis B e antigen (HBeAg) seroconversion, and earlier biochemical response in HBeAg-positive patients (cut-off value: 4 log IU/mL) and an earlier virological response in HBeAg-negative non-cirrhotic patients (cut-off value: 2.4 log IU/mL). Although HBsAg levels decreased slowly during long-term entecavir treatment, higher HBsAg decrease rates were found in the first year for HBeAg-positive non-cirrhotic patients, and patients with higher baseline HBsAg levels. More favorable clinical outcomes were not observed by a rapid HBsAg decline per se, but depended on lower baseline HBsAg levels.
CONCLUSION: Baseline HBsAg can be used to predict treatment responses. HBsAg levels and decrease rates should be considered together according to disease status while interpreting HBsAg changes.
KEYWORDS: Chronic hepatitis B; Entecavir; Hepatitis B e antigen; Hepatitis B surface antigen; Kinetics
共有211名患者入选。中位治疗时间为5.24（2.00-9.62）年。多变量分析显示，较低的基线HBsAg水平与较早的病毒学应答，较早的乙肝e抗原（HBeAg）血清转换和较早的HBeAg阳性患者的生化反应（截断值：4log IU / mL）以及较早的HBeAg阴性非肝硬化患者的病毒学应答（截断值：2.4log IU / mL）。虽然长期恩替卡韦治疗期间HBsAg水平缓慢下降，但在HBeAg阳性非肝硬化患者和基线HBsAg水平较高的患者的第一年发现HBsAg下降率更高。更快的HBsAg下降本身没有观察到更有利的临床结果，但依赖于更低的基线HBsAg水平。
结论：