3年后HbsAg可转阴病人的HbsAg浓度的大样本调查

肝胆速递

http://onlinelibrary.wiley.com/doi/10.1002/hep.25718/abstract

A large case-control study on the predictability of hepatitis B surface antigen levels three years before hepatitis B surface antigen seroclearance†‡
3年后HbsAg可转阴病人的HbsAg浓度的大样本调查

肝胆速递：203例病人调查显示，血液HbsAg浓度小于200IU/ml且每年下降0.5个log值预示3年后HbsAg转阴


Wai-Kay Seto等,
Article first published online: 10 JUL 2012
DOI: 10.1002/hep.25718


    The assays used to determine serum hepatitis B virus DNA levels (Cobas Taqman assay) and hepatitis B surface antigen levels (Elecsys HBsAg II assay) performed in our laboratory were supported by an unrestricted grant from Roche Diagnostics.


Abstract

The kinetics of hepatitis B surface antigen (HBsAg) levels preceding spontaneous HBsAg seroclearance has not been fully investigated. The kinetics of HBsAg and hepatitis B virus (HBV) DNA of 203 treatment-naïve, hepatitis B e antigen (HBeAg)-negative patients with spontaneous HBsAg seroclearance were compared with 203 age- and sex-matched HBeAg-negative controls. Serum samples at 3 years, 2 years, 1 year, and 6 months before HBsAg seroclearance and at the time of HBsAg loss were tested. Median HBsAg levels at these respective time points before HBsAg seroclearance were 23.5, 3.51, 0.524, and 0.146 IU/mL. For all time points, patients with HBsAg seroclearance had significantly lower median HBsAg and HBV DNA levels, compared to those of the controls (all P < 0.001). Median HBsAg and HBV DNA levels declined significantly until HBsAg seroclearance (P < 0.001). Although median HBsAg levels also decreased significantly with time (P = 0.006) in controls, median HBV DNA levels remained similar (P = 0.414). Serum HBsAg levels, followed by HBsAg log reduction, were the best predictors of HBsAg seroclearance, with an area under the receiving operator characteristic (AUROC) of 0.833 (95% confidence interval [CI]: 0.792-0.873) and 0.803 (95% CI: 0.755–0.849), respectively. The optimal cut-off HBsAg level and HBsAg reduction to predict HBsAg seroclearance were <200 IU/mL (sensitivity, 84.2%; specificity, 73.4%) and 0.5 log IU/mL/year (sensitivity, 62.8%; specificity, 88.7%), respectively. For patients with HBsAg levels ≥200 IU/mL, an annual 0.5-log reduction was highly predictive of subsequent HBsAg seroclearance (AUROC, 0.867; 95% CI: 0.778-0.956). Conclusion: To conclude, serum HBsAg <200 IU/mL and 0.5-log reduction in HBsAg were predictive of HBsAg seroclearance within 3 years of follow-up. These parameters may serve as good indicators for the consideration of treatment duration and cessation for chronic hepatitis B. (HEPATOLOGY 2012;56:812–819)

肝胆速递

一个大型的可预测性B型肝炎表面抗原水平前三年乙肝表面抗原转阴的病例对照研究，†‡

    伟凯Seto1，
    丹尼家何Wong1
    詹姆斯Fung1，
    伊万·范艺Hung1
    丹尼尔·意德Fong2，
    约翰·智恒Yuen1
    邓丽君彤，
    李金龙Lai1，3，
    文丰Yuen1，3，§*

在网上公布：2012年7月10日

DOI：10.1002/hep.25718

作者信息

    1

    医学系，香港大学，香港玛丽医院，
    2

    香港玛丽医院，香港大学护理学系，
    3

    香港玛丽医院，香港大学肝病研究国家重点实验室，

    §

    传真：（852）28162863

电子邮件：文凤园（[email protected]）

，香港玛丽医院，薄扶林道香港大学医学系

    †

    潜在的利益冲突：无报告。
    ‡

    用于确定血清乙肝病毒DNA水平（COBAS TaqMan分析）和乙肝表面抗原水平（Elecsys2010的乙型肝炎表面抗原（HBsAg）第二法）在我们的实验室进行检测，由罗氏诊断不受限制的资金支持。


抽象

B型肝炎表面抗原（HBsAg）前自发乙肝表面抗原转阴的动力学还没有得到充分的调查。乙型肝炎表面抗原（HBsAg）和乙肝病毒（HBV）DNA 203治疗初治，乙肝e抗原（HBeAg）阳性阴性的患者乙肝表面抗原转阴自发的动力学203年龄和性别相匹配的HBeAg阴性对照组进行了比较。血清样本在3年，2年，1年，6个月前乙肝表面抗原转阴，HBsAg消失的时间进行了测试。前HBsAg血清清除HBsAg水平在这些各个时间点的中位数为23.5，3.51，0.524和0.146 IU / mL的。所有的时间点，乙肝表面抗原转阴的患者有显着较低的平均HBsAg和HBV DNA水平，而对照组（P <0.001）。中位数HBsAg和HBV DNA水平下降明显，直到乙肝表面抗原转阴（P <0.001）。虽然HBsAg水平中位数也下降显着，与对照组（P = 0.006），HBV DNA中位数水平相似（P = 0.414）。血清HBsAg水平，随后数减少由乙肝表面抗原，乙肝表面抗原转阴的最好的预测，下面积的接收操作特性（AUROC）为0.833（95％信心区间[CI]：0.792-0.873）和0.803（95％CI ：0.755-0.849）。切断乙肝表面抗原的最佳水平和HBsAg减少预测HBsAg血清清除<200 IU /毫升（敏感性84.2％，特异性为73.4％）和0.5日志IU /毫升/年（敏感性为62.8％，特异性88.7％）分别。对于患者的HBsAg水平≥200 IU / mL的高度预测随后的乙肝表面抗原转阴，每年减少0.5日志（AUROC，0.867; 95％CI：0.778-0.956）。结论：得出结论，血清HBsAg <200 IU / mL和0.5数减少乙型肝炎表面抗原（HBsAg），乙肝表面抗原转阴在3年的随访预测。这些参数可以作为考虑为慢性肝炎，B.（2012肝病的治疗时间和停止的良好指标; 56:812-819）

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