血清乙肝表面抗原水平预测e抗原Seroconverters的表面抗原丢失

StephenW

http://www.gastrojournal.org/article/S0016-5085%2811%2900601-9/abstract
Serum Hepatitis B Surface Antigen Levels Predict Surface Antigen Loss in Hepatitis B e Antigen Seroconverters血清乙肝表面抗原水平预测乙型肝炎e抗原Seroconverters的表面抗原丢失

• Tai–Chung Tseng,Chun–Jen Liu,Tung–Hung Su,Chia–Chi Wang,Chi–Ling Chen,
• Pei–Jer Chen,Ding–Shinn Chen,Jia–Horng Kao
  

Background & AimsLoss of hepatitis B surface antigen (HBsAg) usually indicates that hepatitis B virus (HBV) infection has been cured. However, little is known about factors predicting HBsAg loss in patients who spontaneously clear hepatitis B e antigen (HBeAg).
MethodsWe studied 390 Taiwanese HBeAg-positive patients with chronic hepatitis who had spontaneously cleared HBeAg (seroconversion) during follow-up. Serum levels of HBV DNA and HBsAg were determined 1 year after HBeAg seroconversion, and their relationships with subsequent HBsAg loss were investigated.
ResultsIn a mean follow-up of 7.4 years, the average annual rate of HBsAg loss was 0.62%. Serum levels of HBsAg and HBV DNA were inversely associated with HBsAg loss in a dose-response manner. Compared with patients with HBsAg levels ≥1000 IU/mL, the HBsAg loss rate was higher for those with HBsAg levels of 100 to 999 and <100 IU/mL, with hazard ratios of 4.4 (95% confidence interval, 1.1–17.0) and 24.3 (8.7–67.5), respectively. Among those who underwent HBsAg loss within 6 years of follow-up, serum HBsAg levels were a better predictor than HBV DNA levels by receiver operating characteristic curve analysis (area under the receiver operating characteristic curve, 0.90 vs 0.69; P = .012); an HBsAg level <100 IU/mL predicted HBsAg loss within 6 years with a diagnostic accuracy of 91.5%, sensitivity of 83.3%, specificity of 92.1%, positive predictive value of 45.5%, and negative predictive value of 98.6% in patients with an HBV DNA level <200 IU/mL.
ConclusionsLow serum levels of HBsAg, alone or in combination with HBV DNA levels, 1 year after HBeAg seroconversion can predict HBsAg loss in patients with HBV genotype B or C infection.

StephenW

谷歌翻译
不是100％正确，仅供参考使用。

背景及目的

乙肝表面抗原（HBsAg）的损失通常表明，乙型肝炎病毒（HBV）感染已治愈。然而，鲜为人知的是预测患者HBsAg消失的因素，他们自发明确乙肝e抗原（HBeAg）。
方法

我们研究了慢性肝炎，曾自发地清除e抗原（血清转换），随访期间390台湾HBeAg阳性患者。 1年后HBeAg血清转换，HBV DNA和HBsAg血清测定与随后的HBsAg消失关系进行了调查。
结果

在一个平均随访7.4年，HBsAg消失的平均年增长率为0.62％。血清HBsAg和HBV DNA水平呈负相关，与HBsAg中的剂量 - 反应方式损失。与患者HBsAg水平相比≥1000国际单位/毫升，HBsAg消失率较高的HBsAg水平100至999和<100 IU/ mL的危险比为4.4（95％可信区间为1.1-17.0），和24.3（8.7-67.5）。在那些接受6年的随访内HBsAg消失，血清HBsAg水平的工作特征曲线分析（面积比HBV DNA水平由接收器能更好地预测受试者工作特征曲线下，0.90比0.69，P =0.012）; HBsAg水平<100 IU/ mL的乙肝表面抗原在6年亏损的诊断准确率91.5％，83.3％的敏感性，特异性为92.1％，阳性预测值45.5％，而与患者的负98.6％的预测值预测HBV DNA水平<200 IU/毫升。
结论

低血清乙肝表面抗原，单独或与HBV DNA水平，HBeAg血清转换后1年内相结合，可以预测乙肝表面抗原在HBV基因型B型或C感染患者的损失。

把握当下

很有价值啊
ConclusionsLow serum levels of HBsAg, alone or in combination with HBV DNA levels, 1 year after HBeAg seroconversion can predict HBsAg loss in patients with HBV genotype B or C infection.
结论：单一的血清s抗原低值，或者血清s抗原低值+血清DNA低值，可用于预测e抗原血清转化一年之后的HBV病人（B或C基因型）s抗原转阴情况

我理解这个结论其实老王一直在实践

把握当下

有价值的其实是数字，不过我没有完全搞明白
Among those who underwent HBsAg loss within 6 years of follow-up, serum HBsAg levels were a better predictor than HBV DNA levels by receiver operating characteristic curve analysis (area under the receiver operating characteristic curve, 0.90 vs 0.69; P = .012);
6年随访s抗原loss（转阴？）病人中，血清s抗原水平比HBV DNA 水平预测更可靠（。。。某曲线预测方法。。不看了）
an HBsAg level <100 IU/mL predicted HBsAg loss within 6 years with a diagnostic accuracy of 91.5%, sensitivity of 83.3%, specificity of 92.1%, positive predictive value of 45.5%, and negative predictive value of 98.6% in patients with an HBV DNA level <200 IU/mL.
预测：s抗原<100 IU/mL 预示6年内s抗原将消失（转阴），该预测的诊断准确性达到 91.5%，灵敏度达到83.3%（不清楚与准确性什么关系），特异性达到92.1%（不懂）
对于 HBV DNA <200 IU/mL的病人而言，“血清低值的s抗原6年内消失”（positive predictive value）达到45.5%，“不消失”（negative predictive value）达到98.6%（这个翻译明显有问题，但是我实在不知道到底原文啥意思，大家来读读吧）

把握当下

ResultsIn a mean follow-up of 7.4 years, the average annual rate of HBsAg loss was 0.62%. Serum levels of HBsAg and HBV DNA were inversely associated with HBsAg loss in a dose-response manner.
平均7.4年的随访表明：s抗原年平均转阴率为0.62%。HBsAg和HBV DNA血清水平越高，s抗原转阴可能性越低（inversely associated 。。。in a dose-response manner）
Compared with patients with HBsAg levels ≥1000 IU/mL, the HBsAg loss rate was higher for those with HBsAg levels of 100 to 999 and <100 IU/mL, with hazard ratios of 4.4 (95% confidence interval, 1.1–17.0) and 24.3 (8.7–67.5), respectively.
与s抗原≥1000 IU/mL的病人相比，s抗原在100-999区间和 <100 IU/mL区间的病人的s抗原转阴率为4.4（可信区间95%，1.1–17.0）、 24.3 （8.7–67.5）（括号内数字不明白）

StephenW

把握当下 发表于 2011-8-11 18:46
很有价值啊
ConclusionsLow serum levels of HBsAg, alone or in combination with HBV DNA levels, 1 year ...

"我理解这个结论其实老王一直在实践"

但是，老王没有调查血清HBsAg水平和year-to-clearance的确切关系。这关系显然不是一条直线。您必须阅读整份文件。

把握当下

StephenW 发表于 2011-8-11 21:01
"我理解这个结论其实老王一直在实践"

但是，老王没有调查血清HBsAg水平和year-to-clearance的确切关系。 ...

恩，我想他应该是有一些数据的，也许还不完善，毕竟表面抗原转阴的很少
无论学术理论还是实践都需要人做，学术理论现状我不了解，不过我觉得老王无疑是杰出的实践派

an HBsAg level <100 IU/mL predicted HBsAg loss within 6 years with a diagnostic accuracy of 91.5%, sensitivity of 83.3%, specificity of 92.1%, positive predictive value of 45.5%, and negative predictive value of 98.6% in patients with an HBV DNA level <200 IU/mL.
后面“positive predictive value of 45.5%, and negative predictive value of 98.6% ”这个我不明白，是什么意思你知道吗？

StephenW

回复 把握当下 的帖子

I think it means:

1) in patients with an HBsAg level <100 IU/mL predicted HBsAg loss within 6 years with a diagnostic accuracy of 91.5%, sensitivity of 83.3%, specificity of 92.1%, positive predictive value of 45.5%
2)in patients with an  200 IU/mL > HBsAg level > 100 IU/ml has negative predictive value of 98.6%.

Therefore, in patients with HBsAg level > 100 IU/ml, you can't predict. This is my interpretation without reading the whole paper.

For a doctor, to predict is not to cure.

把握当下

StephenW 发表于 2011-8-11 22:32
回复 把握当下 的帖子

I think it means:

我觉得你对predictive value的理解很对

不过原文说的是“patients with an HBV DNA level <200 IU/mL.”，不是你说的“200 IU/mL > HBsAg level > 100 IU/ml ”？
那对比的就是：
1.patients with an HBsAg level <100 IU/mL    45.5% positive, diagnostic accuracy of 91.5%, sensitivity of 83.3%, specificity of 92.1%
2.patients with an HBV DNA level <200 IU/mL   98.6% negative
这一段其实讲的是预测方法本身，跟预测数据到底是什么的没关系
那么这个对比是想说明s抗原比dna更具指标意义吗？（serum HBsAg levels were a better predictor than HBV DNA levels）
如果是的话，这个比较我觉得太无聊了，明显是事实嘛

下面这段才是讲预测数据的吧：
Compared with patients with HBsAg levels ≥1000 IU/mL, the HBsAg loss rate was higher for those with HBsAg levels of 100 to 999 and <100 IU/mL, with hazard ratios of 4.4 (95% confidence interval, 1.1–17.0) and 24.3 (8.7–67.5), respectively.
我的理解是：（忽略测试方法相关数据）
与s抗原≥1000 IU/mL的病人相比，s抗原在100-999区间和 <100 IU/mL区间的病人的s抗原转阴率更高，分别为4.4%、 24.3 %

我的理解对吗？

StephenW

回复 把握当下 的帖子

"我的理解对吗？" - No, I stand by my previous explanation. What you interpret is also unusual: "s抗原在100-999区间和 <100 IU/mL,"  is the same as "s抗原< 1000 IU/mL".

In the abstract, the authors tried to summarize a complex relation between level of HBsAg and clearance, the description is not easy or clear, so best to read the whole paper. It has been known by people more experienced than me, like our Italian friend, Stef0211, that if your HBsAg level is < 100 IU/mL, then you have a very good chance of seroconverting HBsAg.

qHBsAg (quantitive) assay is not available to patients in Australia and America, it is used for research only. Many testing laboratories will only report a exact result of < 250 IU/mL or just > 250 (which could mean 1000, 10,000, or 100,000...).

In my opinion, knowing your qHBsAg at this stage, serves no useful purpose. It is good news if you have < 100 IU/mL, but what does it mean if you have > 1000?