EASL2012:THE SIGNIFICANCE OF VIRAL AND SEROLOGICAL MARKERS IN PREDICTING LIVER D

StephenW

Abstract               
                                

Title	THE SIGNIFICANCE OF VIRAL AND SEROLOGICAL MARKERS IN PREDICTING LIVER DISEASE SEVERITY IN e-AG NEGATIVE HEPATITIS B VIRUS INFECTION
Speaker:	Vinod   Audimoolam
Author:	V.K. Audimoolam*, I. Carey, A. Suddle, M. Bruce, M. Horner, K. Agarwal, P.M. Harrison
Affiliation:	King's College Hospital, London, UK. *[email protected]
Background and aims: In hepatitis B virus (HBV)infection, seroconversion to HBeAg negative/eAb positive accompanied by low serumHBV-DNA (persistently ≤2000 IU/mL) and low quantitative HBsAg (qHBsAg)signifies transition to an inactive carrier (IC) state. However, in patientswith raised serum HBVDNA differentiating those with inactive disease (ID) fromeAg negative chronic HBV (eAg-CHB) currently relies on liver biopsy. This studyinvestigated whether serological (qHBsAg) and virological markers (serumHBV-DNA) can predict disease severity in patients with eAg negative HBV acrossa range of HBV genotypes. Methods: Liver biopsy was performed in 364 consecutiveeAg negative patients (median age 38 years, 212 males) who had HBVDNA >1000IU/ml on at least 2 clinic visits over 6-18 months. ALT [IU/l], qHBsAg [Abbott ARCHTECT®], HBVgenotype [direct sequencing] and HBV-DNA [real-time TaqMan PCR] were evaluated at the time of liver biopsy. Results: Based on the liver histologyfindings, 217 had ID (an Ishak fibrosis score of F0-1) and 147 had eAg-CHB(≥F2). HBV genotype-E predominated (50%) followed by D (16%), A (15%), B (10%)and C (9%). Overall qHBsAg levels were higher in ID than eAg-CHB patients (median3.84 vs. 3.7 log10IU/ml;p=0.02). Assessment by individual genotype demonstrated that qHBsAg levels remainedhigher in ID than eAg-CHB in genotypes A and E (4.01 vs. 3.73 and 3.95 vs. 3.8 log10IU/ml; both p< 0.05).However, in genotype B qHBsAg levels correlated with the severity of fibrosis [2.81in F0-1 vs. 3.34 in F≥2; p< 0.01]. The qHBsAg levels were similar in ID andeAg-CHB in genotypes C and D. HBV genotype had no impact on the severity ofliver fibrosis (p=0.16). Patients with eAg-CHB compared to those with ID hadraised ALT [81% vs. 65 %; p< 0.01], higher HBV-DNA (3.99 vs. 3.6 log10IU/ml; p< 0.01), olderage (39 vs. 36 years; p< 0.01) and more were males (68% vs. 51%; p< 0.01). Conclusion: In eAg negative patients with HBVDNA >1000 IU/ml, the relationship between qHBsAg levels and liver fibrosiswas genotype specific. Even allowing for HBV genotype, the absolute qHBsAg levelwas a poor discriminator of clinically significant liver fibrosis.

StephenW

标题的病毒和血清学指标在肝病的严重程度预测中的E-AG阴性乙型肝炎病毒感染的意义
主讲人：维诺德Audimoolam
作者：V.K. * audimoolam，凯里一，A. Suddle，M.布鲁斯，M.霍纳，光阿加瓦尔，下午哈里森
单位：英国伦敦国王学院医院。 * vinod.audimoolam @ nhs.net
背景和目标：在B型肝炎病毒（HBV）感染，转阴到HBeAg的负面/ EAB积极的陪同下坚持低血清HBV-DNA（≤2000 IU /毫升）和低定量乙肝表面抗原（qHBsAg）标志着过渡到一个无效的载体（IC ）状态。然而，在提高血清HBVDNA含量区别于无效病（ID）的EAG阴性的慢性HBV（EAG CHB）的患者目前依赖于肝活检。本研究血清（qHBsAg）的和病毒学标志物（血清HBV-DNA）是否可以预测EAG跨越了一系列的乙肝病毒基因型阴性乙肝患者疾病的严重程度。
方法：364连续EAG阴性的患者（平均年龄38岁，212名男性）进行肝活检有HBV  -  DNA> 1000 IU /毫升6-18个月，至少有2就诊。 ALT键[IU / L]，qHBsAg [雅培ARCHTECT®]，HBV基因型直接测序和HBV-DNA的实时荧光定量PCR检测肝活检时评估。
结果：肝组织学检查结果，217基于ID（Ishak纤维化评分F0-1）和147 EAG慢性乙型肝炎（≥F2），。 HBV基因型-E的占大多数（50％），其次是D类（16％），（15％），B组（10％）和C（9％）。的整体qHBsAg水平ID高于EAG CHB患者（中位数3.84与3.7 log10IU/ml的P = 0.02）。评估个别证明基因型，qHBsAg水平保持在ID基因型高于东亚运动会的慢性乙型肝炎的A和E（4.01与3.73和3.95与3.8 log10IU/ml;均P <0.05）。然而，B基因型qHBsAg水平与纤维化程度[2.81，F≥2 F0-1与3.34，P <0.01]。 qHBsAg水平在基因型相似的ID和东亚运动会的慢性乙型肝炎，C和D HBV基因型对肝纤维化的严重程度（P = 0.16）没有影响。 EAG的慢性乙型肝炎患者相比，那些与ID已提出[81％与65％，P <0.01]（ALT），较高的乙肝病毒的DNA（3.99与3.6 log10IU/ml的; P <0.01），年龄（39主场迎战36岁，P <0.01），多为男性（68％比51％，P <0.01）。
结论：在eAg阴性与HBV DNA> 1000 IU /毫升患者, qHBsAg水平和肝纤维化之间的关系具体基因型。即使HBV基因型，绝对qHBsAg水平是不准确的临床显着的肝纤维化鉴别。