乙肝表面抗原定量的临床应用CLINICAL APPLICATION OF QUANTITATIVE HBsA

StephenW

CLINICAL APPLICATION OF QUANTITATIVE HBsAg

血清HBV DNA的相关性
虽然测定血清乙肝病毒DNA是监测病毒载量的金标准，它是相对昂贵，尚未在一些地区随时可用。与此相反，用于检测qHBsAg技术是相当容易和便宜，而初始临床研究的主要目的是要确定与qHBsAg和血清HBV DNA（表（表1）.1）的关系。 2004年，Deguchi等[
23]首次报道了患者的临床意义高qHBsAg谁是B型肝炎e抗原（HBeAg）阳性，而不是用抗体阳性乙肝e抗原（抗- HBe）阳性者，而qHBsAg相关，与血清HBV DNA水平（r=0.862）很好。虽然有是否qHBsAg与血清HBV DNA[26,27]相关的一些矛盾的结果，看来他们是根据相关的一些研究[28-33]。需要进一步研究，探讨了作为一个援助qHBsAg的可能性，如果不是一种选择，为乙肝病毒的DNA。

Correlation with serum HBV DNA

Although measuring serum HBV DNA is the gold standard for monitoring viral load, it is relatively expensive and not yet readily available in some areas. By contrast, the technique for detecting qHBsAg is fairly easy and inexpensive, and the primary aim of initial clinical studies was to determine the relationship between qHBsAg and serum HBV DNA (Table ​(Table1).1). In 2004, Deguchi et al[23] first reported the clinical significance ofa high qHBsAg in patients who were hepatitis B e antigen (HBeAg) positive as opposed to those with an antibody positive to the hepatitis B e antigen(anti-HBe), and that qHBsAg correlated well with the serum HBV DNA level (r= 0.862). Although there are some contradicting results on whether qHBsAg is correlated with serum HBV DNA[26,27], it seems that they are correlated based on a number of studies[28-33]. Further studies are required to investigate the possibility of using qHBsAg as an aid, if not an alternative, for HBV DNA.

以共价闭合环状DNA的相关性一个重要的问题是它与qHBsAg共价闭合环状DNA（cccDNA的）的关系。 cccDNA的是一个小型的染色体和病毒模板行为和
维持慢性乙肝病毒感染补益池[34]。因此，有必要了解乙肝病毒cccDNA的生物学治疗时考虑。然而，研究cccDNA的，一侵入性操作是必需的，qHBsAg已作为替代标记
的cccDNA的建议。 Werle- Lapostolle等人[29]报道了在cccDNA的显着减少，qHBsAg
，血清乙肝病毒DNA与阿德福韦（2009/07）治疗，并有一个与其他变量之间cccDNA的很强的相关性。这一观察是支持的后续研究; Wursthorn等[35]，陈等人[36]也表明，与
qHBsAg cccDNA的相关显着，表明qHBsAg可能作为一种额外的标记法来评价抗病毒治疗过程中监测治疗反应的序列。

Correlation with covalently closed circular DNA

An important qHBsAg issue is its association with covalentlyclosed circular DNA (cccDNA). cccDNA is a mini-chromosome and acts as a viraltemplate and replenishing pool for maintaining a chronic HBV infection[34]. Therefore, it is essential to understandthe biology of cccDNA when considering HBV therapy. However, to examine cccDNA,an invasive procedure is required, and qHBsAg has been suggested as a surrogate marker for cccDNA. Werle-Lapostolle et al[29] reported a significant decrease in cccDNA,qHBsAg, and serum HBV DNA with adefovir (ADV) therapy, and that there was astrong correlation between cccDNA and other variables. This observation was supported by subsequent studies; Wursthorn et al[35] and Chan et al[36] also showed that cccDNA was significantly correlated with qHBsAg, suggesting that serial monitoring of qHBsAg might act as an additional marker to evaluate treatment response during antiviral therapy.

预测抗病毒治疗的反应后确认qHBsAg数据的积累，可以用来作为一种病毒监测，
qHBsAg已作为评估的病毒学应答的预测。在一项由陈等人[36]的敏感性，特异性和持续病毒反应阳性和阴性预测值研究（SVR）的聚乙二醇干扰素与聚乙二醇（PEG-
干扰素）+拉米夫定治疗的患者（林）分别为86％，56％ ，43％和92％的基准qHBsAg
浓度小于10000国际单位/毫升，分别。根据Manesis数据等[31]实现彻底消除乙肝表面抗原很可能会要求林10.6岁的有效治疗或5.4的持久办法干扰素年。最近，关于处理
qHBsAg在用PEG-干扰素治疗的患者临床±林用处都已经建议在HBeAg阳性和阴性的患者，一个在>1登录国际单位qHBsAg/ mL或0.5和1.0具体日志国际单位/毫升下降
12和24周时，分别有较高的SVR的预测值，并在处理HBsAg水平可作为一种耐用非早期预测治疗反应用于聚乙二醇化干扰素为基础的治疗[32,33,37]。值得注意的是Marcellin
等[38]长期的研究，其中35例谁qHBsAg<1500国际单位/毫升％，在第12周，最终
清除四年后处理，它支持qHBsAg HBsAg的临床应用。此外，qHBsAg优于预测
在接受聚乙二醇干扰素为基础的接受者操作特征疗法（02）以cccDNA的SVR的患者血清HBV DNA和曲线0.769，0.734和0.714，分别为[39]。

Prediction of response to antiviral therapy

After the accumulation of data confirming that qHBsAg can beutilized as a viral monitor, qHBsAg has been evaluated as a predictor of virologic response. In a study by Chan et al[36] the sensitivity, specificity, and positive and negative predictive values for sustained virologic response (SVR) in patients treated with pegylated interferon (Peg-IFN) + lamivudine (LAM) were 86%, 56%, 43%, and 92%, respectively, with baseline qHBsAg concentrations less than 10 000 IU/mL. According to the data of Manesis et al[31] achieving the complete elimination of HBsAg would probably require 10.6 years of effective LAM therapy or 5.4 years of a sustained response to interferon. Recently, the clinical usefulness of on-treatment qHBsAg in patients treated with Peg-IFN ± LAM has been suggested in both HBeAg positive and negative patients; a decline in qHBsAg of > 1 logIU/mL or specifically 0.5 and 1.0 log IU/mL at weeks 12 and 24, respectively,had high predictive value for SVR, and on-treatment HBsAg levels could be used as an early predictor of durable off-treatment response to Peg-IFN-based therapy[32,33,37].Of note is a long-term study by Marcellin et al[38]in which 35% of patients who had qHBsAg < 1500 IU/mL at week 12 eventually cleared the HBsAg by 4 years post-treatment, which supports the clinical utility of qHBsAg. Furthermore, qHBsAg was superior to cccDNA and serum HBV DNAfor predicting SVR in patients undergoing Peg-IFN-based therapy with receiver operating characteristic (ROC) curves of 0.769, 0.734, and 0.714, respectively[39].

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lin12345

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