AASLD 2011:Quantitative HBsAg is a poor marker of chronic hepatitis B inactive c

StephenW

Quantitative HBsAg is a poor marker of chronic hepatitis B inactive carriage
F. Napoli1; Y. Ngo2; T. Poynard2, 3; V. Thibault1
1. Virology - CERVI, Pitie-Salpetriere Hospital, Paris cedex 13, France.
2. Hepato-Gastroenterology, AP-HP Pitie-Salpetriere Hospital, Paris, France.
3. UMR 8149, CNRS, Paris, France.


Quantitative HBsAg measurement (qHBsAg) has been proposed as an additional predictive marker to accurately classify inactive chronic hepatitis B (CHB) carriers. A retrospective analysis was conducted to analyze the values and evolution of qHBsAg over a 3 year period in CHB according to standard definition of inactive carriage (IC). HBsAg was quantified from serum taken at two time points from 41 patients classified as IC according to the definition of Ngo et al. (2008 Plos One 3(7): e2573) and followed for a mean period of 3.2 years. Patient mean age was 36 yo. (±1.6) and 46% were males. 39% (16) of these patients were defined as IC according to classical criteria: HBeAg negative, HBV-DNA< 2000 IU/mL and persistently normal ALT, with an ALT upper limit set as 26 IU/L. On the first time point, the mean (SE) qHBs value was 7582 IU/mL (±2378). 13 (32%) patients had qHBsAg below 1000 IU/mL but were equally distributed in IC and non IC. On follow-up, a significant (p=0.026) drop of 19% was noticed with a mean qHBsAg at 5793 IU/mL (±1438) and 2 additional patients (37%) reached a value below 1000 IU/mL. No difference in qHBsAg decrease was seen between patients with an initial value below or above 1000 IU/mL. Moreover, no significant qHBsAg difference was observed between IC (standard criteria) and non-IC patients; qHBsAg values at the first time point were 12523 (±5748) and 4420 (±1083) IU/mL, respectively. The same conclusion was verified at the second time point. Over the three year period, 17% of patients had an increase over 10% of qHBsAg, 20% had a qHBsAg steady level (a fluctuation of less than ±10%) and 63% had a decrease over 10%, with a mean decline of 42% (±5). Evolution of qHBsAg over time was not linked to the IC status. Predictive factors based on qHBsAg for accurate classification of IC were assessed using receiver operator characteristics and the best area under curve was obtained after calculation of qHBsAg drop per year with a value of 0.73 IU/mL (±0.081). However, none of the studied parameters (absolute value, drop, kinetics) reached a strong enough predictive value compatible with clinical use. Although different qHBsAg thresholds have been proposed to classify inactive carriers, a dynamic appraisal on at least 2 time points maybe more relevant. Yet, no clinically appropriate algorithm based solely on qHBsAg could be found to accurately classify IC. Regulation of HBsAg production during CHB is complex and single measurement of qHBsAg seems inadequate as predictive marker for inactive carriage in clinical practice.

StephenW

HBsAg的定量是差的慢性乙肝无效运输标志
F.那不勒斯1; Y.鹤2; T. Poynard 2，3;五蒂博1
1。病毒学 - 宫颈，Pitie Salpêtrière医院，13日，法国巴黎CEDEX。
2。肝，胃肠病，AP - HP Pitie Salpêtrière医院，法国巴黎。
3。 UMR 8149 CNRS，巴黎，法国。


HBsAg的定量测量（qHBsAg）已建议作为一个额外的预测指标，准确分类不活跃的慢性乙型肝炎（HBV）携带者。进行回顾性分析来分析在CHB不活跃的运输标准清晰度（IC）的3年期的价值观和qHBsAg演变。乙肝表面抗原定量从两个时间点采取血清41例，根据非政府组织等的定义，归类为IC。 （2008年PLoS ONE的3（7）：e2573）和平均周期为3.2年。病人的平均年龄为36岁。。 （± 1.6）和46％为男性。这些患者中有39％（16）根据古典的标准定义为IC：HBeAg阴性，HBV - DNA <2000 IU / mL和ALT持续正常，与上设置限制一个ALT 26 IU / L。在第一个时间点，平均（SE）qHBs价值是7582国际单位/毫升（± 2378）。 13（32％）患者qHBsAg低于1000国际单位/毫升，但也同样分布在IC和非IC。在跟进，显着性（P = 0.026）下降19％，平均在5793 qHBsAg注意到国际单位/毫升（± 1438）和2名患者（37％）达到了低于1000 IU / mL的价值。与初始值低于或高于1000 IU / mL的患者之间没有差异qHBsAg减少。此外，观察IC（标准）和非IC患者之间无显着性qHBsAg差异; qHBsAg在第一时间点的值分别为12523（± 5748）和4420（± 1083）IU / ml，分别。在第二个时间点相同的结论进行了验证。在三年期间，17％的患者已增加超过10％的qHBsAg，20％有qHBsAg稳定的水平（超过± 10％以内的波动）和63％，平均下降了减少10％以上， 42％（± 5）。随着时间的推移qHBsAg的演变是不挂钩的IC状态。基于IC准确分类qHBsAg的预测因素评估，使用接收器的操作特点和最好的曲线下面积计算qHBsAg值0.73国际单位/毫升（± 0.081）每年下降后获得。但是，没有研究参数（绝对值下降，动力学）达到了一个足够强大的预测值与临床使用的兼容。虽然不同qHBsAg的阈值已建议进行分类至少2个时间点，也许更多相关的非活动载体，动态考核。然而，单靠qHBsAg没有临床合适的算法可以找到准确分类IC。规例的HBsAg在慢性乙型肝炎是复杂和单qHBsAg测量的生产似乎不足以作为预测指标在临床实践中无效运输。

一般都能

论文作者没有提到所用的仪器，没有考虑到测量仪器的误差，其结论可能存在严重的问题。

StephenW

一般都能 发表于 2011-10-27 07:23
论文作者没有提到所用的仪器，没有考虑到测量仪器的误差，其结论可能存在严重的问题。 ...

这是可能的。也许他们的稀释是错误的？

interdetect

StephenW 发表于 2011-10-26 13:32
Quantitative HBsAg is a poor marker of chronic hepatitis B inactive carriage
F. Napoli1; Y. Ngo2; T. ...

你知道AASLD 2011年出guideline吗？

StephenW

interdetect 发表于 2011-10-27 13:23
你知道AASLD 2011年出guideline吗？

我认为下一个的guideline，将在2013年出版。但guideline
在需要时更新.