HBsAg定量在自然历史和核苷（酸）类似物治疗慢性乙型肝炎的

StephenW

http://link.springer.com/article/10.1007/s00535-012-0668-y?no-access=true
Journal of Gastroenterology
January 2013, Volume 48, Issue 1, pp 13-21
Clinical utility of quantitative HBsAg in natural history and nucleos(t)ide analogue treatment of chronic hepatitis B: new trick of old dog

    Tai-Chung Tseng,
    Jia-Horng Kao

Abstract

Using commercial quantitative assays, quantitative hepatitis B surface antigen (qHBsAg) has improved our understanding and management of chronic hepatitis B (CHB). The HBsAg level is highest in the immune tolerance phase, starts to decline during the immune clearance phase, and decreases slowly but progressively after hepatitis B e antigen (HBeAg) seroconversion. The HBsAg level is lowest in individuals with an inactive carrier state but higher in those who develop HBeAg-negative hepatitis. It has been shown that a reduction of HBsAg by 1 log IU/mL or more reflects improved host immune control of HBV infection. A combination of HBsAg <1000 IU/mL and HBV-DNA <2000 IU/mL can identify a 3-year inactive state in a genotype D HBeAg-negative carrier population. In the Asian-Pacific region, where HBV genotypes B and C are dominant, HBsAg levels of ≤10–100 IU/mL predict HBsAg loss over time. As to the prediction of disease progression, low-viremic carriers with HBsAg >1000 IU/mL have been shown to be at higher risks of HBeAg-negative hepatitis, cirrhosis, and hepatocellular carcinoma than those with HBsAg <1000 IU/mL. Although qHBsAg has been widely used in CHB patients receiving pegylated interferon therapy, the HBsAg decline is slow and does not correlate with HBV-DNA levels during nucleos(t)ide analogue (NUC) therapy. However, a rapid HBsAg decline during NUC therapy may identify patients who will finally clear HBsAg. A 6- to 12-monthly assessment of HBsAg level could be considered during NUC therapy. Taking these lines of evidence together, qHBsAg can complement HBV-DNA levels to optimize the management of CHB patients in our daily clinical practice.
Part of this review was presented at The 3rd International Forum of the 98th General Meeting of the Japanese Society of Gastroenterology.

StephenW

曾台中，
    高嘉鸿

摘要
使用商业的定量分析，定量乙肝表面抗原（qHBsAg）提高了我们的认识和管理慢性乙型肝炎（CHB）。 HBsAg水平最高的免疫耐受阶段，在免疫清除期开始下降，后逐步缓慢下降，但B型肝炎e抗原（HBeAg）血清转换。 HBsAg水平是最低的，在个人与惰性载体状态，但较高的发展HBeAg阴性肝炎。它已被证明是减少乙肝表面抗原IU / mL的1log或更反映HBV感染改善宿主的免疫控制的。乙肝表面抗原的组合<1000 IU / mL和HBV-DNA <2000 IU / mL的可识别的D型HBeAg阴性载体人口为期3年的非活动状态。在亚太地区，HBsAg水平≤10〜100 IU / mL的HBV基因型B和C是显性的，随着时间的推移预测HBsAg转阴。至于预测疾病进展，低病毒血症与HBsAg> 1000 IU / mL的载体已被证明是在更高的风险比那些与HBsAg HBeAg阴性肝炎，肝硬化和肝癌的<1000 IU / mL的。虽然qHBsAg已被广泛接受聚乙二醇干扰素治疗慢性乙型肝炎患者，乙肝表面抗原的下降是缓慢的，并没有相关的核苷（酸）类似物（NUC）治疗过程中的HBV-DNA水平。然而，乙肝表面抗原的快速下降NUC治疗过程中可确定患者将最终清除乙肝表面抗原的人。 A 6  -  12个月的评估乙肝表面抗原水平可以考虑在NUC治疗。这些证据，qHBsAg可以在我们日常临床实践中补充，以优化管理的慢性乙型肝炎患者的HBV-DNA水平。
日本胃肠病学会第98届大会提交的第三次国际论坛的这篇评论。

咬牙硬挺

感谢分享

xiangsiwuyong

以前没有检查过，检查的也忘记了具体的数据了，这次检查的HBSAG定量为122.5，不知是福还是祸？盼资深人士解释！

StephenW

回复 xiangsiwuyong 的帖子

以前没有检查过，检查的也忘记了具体的数据了，这次检查的HBSAG定量为122.5，不知是福还是祸？盼资深人士解释！

最重要的是HBSAG定量 122.5 的单位. 如果是 122.5 iu/ml, 目前的研究显示:
1. HBsAg < 100 iu/ml 和 hbvdna < 100 iu/ml, 没有治疗, HBeAg阴性, 可以100%预测处于非活动状态.
2.HBsAg  ≤10–100 IU/mL 预测 随着时间HBsAg将会消失
3. HBsAg < 1000 iu/ml 和 hbvdna < 2000 iu/ml ,准确地识别非活动性携带者。

xiangsiwuyong

StephenW 发表于 2013-1-15 23:01
回复 xiangsiwuyong 的帖子

以前没有检查过，检查的也忘记了具体的数据了，这次检查的HBSAG定量为122.5， ...

hbsag       122.47        单位ng/ml

谢谢答复！这个单位和你说的单位是怎么样个换算法呢？

xiangsiwuyong

StephenW 发表于 2013-1-15 23:01
回复 xiangsiwuyong 的帖子

以前没有检查过，检查的也忘记了具体的数据了，这次检查的HBSAG定量为122.5， ...

hbv-dna     结果小于500       单位拷贝/ml

StephenW

回复 xiangsiwuyong 的帖子

hbsag       122.47        单位ng/ml
这个单位和你说的单位是怎么样个换算法呢？换算法不明确,可以是:
1. 1 ng/ml = 1 iu/ml
2. 1 ng/ml = 0.2 iu/ml

最好使用最新的罗氏或雅培检测

hbv-dna     结果小于500       单位拷贝/ml, 500 copies/ml ~= 500/5.6=89 iu/ml

xiangsiwuyong

StephenW 发表于 2013-1-16 20:10
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hbsag       122.47        单位ng/ml

1=0.2了？？？

StephenW

回复 xiangsiwuyong 的帖子

hbsag       122.47        单位ng/ml
122.47 ng/ml 可以是 24.494 iu/ml