监测HBsAg、HBeAg和DNA水平预测乙肝患者对恩替卡韦治疗的反映

肝胆速递

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2012.01599.x/abstract
Prediction of response to entecavir therapy in patients with HBeAg-positive chronic hepatitis B based on on-treatment HBsAg, HBeAg and HBV DNA levels监测HBsAg、HBeAg和DNA水平预测E抗原阳性乙肝患者对恩替卡韦治疗的反映

    J. W. Shin1,
    S. W. Jung1,
    B. R. Park2,
    C. J. Kim2,
    J. B. Eum1,
    B. G. Kim1,
    I. D. Jeong1,
    S.-J. Bang1,
    S.-H. Lee3,
    S. R. Kim3,
    N. H. Park1,2

Article first published online: 15 MAR 2012

DOI: 10.1111/j.1365-2893.2012.01599.x

    1

    Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
    2

    Biomedical Research Center, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
    3

    Department of Laboratory Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea

*Neung Hwa Park, MD, PhD, Department of Internal Medicine, Ulsan University Hospital, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, Korea. E-mail: [email protected]

Summary.  Quantitative hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) assays are emerging as effective tools of on-treatment predictors of response to antiviral agents, in addition to monitoring serum HBV DNA levels. However, the dynamic relationship between quantitative HBsAg, as well as HBeAg and HBV DNA, and the predictability of subsequent clinical outcomes during entecavir (ETV) therapy remain unclear. Eighty-two patients with HBeAg-positive chronic hepatitis B (CHB) received ETV therapy for ≥3 years. Virologic response (VR) after 3 years of ETV therapy was achieved in 73 (89.0%) patients. Among baseline and on-treatment factors, on-treatment HBV DNA levels performed better with respect to the prediction of response than HBsAg and HBeAg levels. Especially, the performance of absolute values of HBV DNA with respect to response was superior to HBV DNA decline from the baseline. The best predictive value was an absolute HBV DNA level of 2.3 log10 IU/mL at month 6 (areas under the curve [AUROC], 0.977; 95% CI, 0.940–1.000; P < 0.001). HBeAg seroconversion after 3 years of therapy was achieved in 26 (31.7%) patients. On-treatment HBeAg levels performed better with respect to the prediction of seroconversion than HBsAg and HBV DNA levels. The best cut-off value for the HBeAg level at month 12 for the prediction of seroconversion was 0.62 log10 PEIU/mL. Although the HBsAg level at baseline is often used to predict the antiviral potency of entecavir, on-treatment HBV DNA and HBeAg levels are more helpful for prediction of subsequent clinical outcomes in HBeAg-positive CHB patients with entecavir treatment.

肝胆速递

恩替卡韦治疗HBeAg阳性慢性乙型肝炎患者对治疗的HBsAg，HBeAg和HBV DNA水平的基础上预测

    J. W. Shin1，
    S. W. Jung1，
    B. R. PARK2，
    C. J. Kim2，
    J. B. Eum1，
    B. G. Kim1，
    I. D. Jeong1，
    S.-J.帮，
    S.-H. Lee3，
    S. R. Kim3，
    N. H. Park1，2

在网上公布：2012年3月15号

DOI：10.1111/j.1365-2893.2012.01599.x

    1

    蔚山大学医学院，蔚山，韩国，蔚山大学医院内科，
    2

    蔚山大学医学院，生物医学研究中心，蔚山，韩国蔚山大学医院
    3

    蔚山大学医学院，蔚山，韩国，蔚山大学医院检验科，

*陵华公园，医学博士，哲学博士，内科部，蔚山大学医院，290-3 Jeonha洞区，韩国蔚山682-714。电子邮箱：[email protected]的

总结。定量乙肝表面抗原（HBsAg）和乙肝e抗原（HBeAg）检测正成为有效的抗病毒药物对治疗的预测工具，除了监测血清HBV DNA水平。然而，HBsAg定量，以及HBeAg和HBV DNA，并在恩替卡韦（ETV）治疗后临床结果的可预测性之间的动态关系仍不清楚。 82例接受ETV治疗HBeAg阳性慢性乙型肝炎（CHB）≥3年。病毒学应答（VR）ETV治疗3年后，73例患者（89.0％）。其中基线和治疗因素，对治疗的HBV DNA水平的表现更好的相对于的预测中的HBsAg和HBeAg水平的反应比。尤其是，相对于反应的性能的HBV DNA的绝对值是优于从基线的HBV DNA的下降。最好的预测值是一个绝对的HBV DNA水平的2.3 log10的国际单位/毫升（曲线下面积在6个月AUROC，0.977; 95％CI 0.940-1.000，P <0.001）。经过3年的治疗，26例（31.7％），HBeAg血清学转换。对治疗HBeAg水平进行更好的预测比HBsAg和HBV DNA水平转阴。截止最好的HBeAg水平在12个月的血清学转换的预测值分别为0.62 log10的PEIU /毫升。虽然在基线HBsAg水平经常被用来预测恩替卡韦抗病毒能力，对治疗HBV DNA和HBeAg水平更有利于随后的恩替卡韦治疗HBeAg阳性CHB患者的临床结果的预测。