EASL 2013:乙肝表面抗原在确定真正的非活动性C基因携带者

StephenW

Abstract 436
在确定真正的非活动性HBsAg携带者感染C基因型乙肝病毒，乙肝表面抗原中的作用
ROLE OF HEPATITIS B SURFACE ANTIGEN IN IDENTIFYING TRUE INACTIVE HBSAG CARRIERS INFECTED WITH GENOTYPE C HEPATITIS B VIRUS   

S.Y. Yim*, S.H. Um, Y.S. Seo, H.S. Ryu
Internal Medicine, Korea University, Seoul, Republic of Korea. *[email protected]

Background and aim: Inactive and active phases of hepatitis B e antigen (HBeAg)-negative chronic hepatitis B virus (HBV) infection are diagnosed by serum HBV DNA levels, with cutoff at 2000 IU/mL. However, it is difficult to distinguish inactive carriers from HBeAg-negative chronic hepatitis B patients at a single time point because of frequently fluctuating HBV DNA levels in the latter group. Therefore we aimed to establish the role of serum hepatitis B surface antigen (HBsAg) in identifying “true inactive carriers” among treatment-naïve genotype C HBV-infected patients.
Methods: A total of 133 HBeAg-negative carriers with serum HBV DNA levels of < 2000 IU/mL and normal alanine aminotransferase levels were enrolled and followed up for >12 months. Baseline clinical characteristics, quantitative HBsAg using ARCHITECT assay, serum HBV DNA levels and biochemical factors were reviewed.
Results: Thirty-six patients (27%) showed HBV reactivation (HBV DNA, ≥2000 IU/mL) during 12 months from enrollment. Baseline serum HBsAg levels and HBV DNA levels were associated with HBV reactivation (both,P< 0.001). The predictive efficacy in identifying persistently inactive carriers was the highest for the combination of HBV DNA and HBsAg, followed by HBV DNA and HBsAg (AUROC=0.784, 0.735 and 0.722, all P< 0.001). However, no baseline serum HBV DNA levels could identify inactive carriers with 100% specificity, while baseline serum HBsAg levels (49.45 IU/mL) and combination of both (125 IU/mL and 332 IU/mL) identified true inactive carriers with 100% specificity and detection rate of 27.8%, 30.9%, respectively. Detection rate increased when different HBsAg cutoff levels were applied to different age groups according to median age (46 years). It was comparable in both younger and older groups (37.2% vs 35.2%) even when HBsAg cutoff level was increased in the former (488 IU/mL vs 49.45 IU/mL). Furthermore, no HBV reactivation occurred during long-term follow-up when these cutoff levels were applied.
Conclusion: Baseline serum HBsAg levels at a single time point can identify persistently true inactive carriers, with different cutoff levels according to age. Thus, frequent monitoring may be unnecessary for low-viremic patients with baseline serum HBsAg levels below these cutoff levels, considering the cost and low incidence of disease progression.


Assigned speakers:
Dr. Sun Young Yim, Korea University , Seoul , Republic of Korea

Assigned in sessions:
25.04.2013, 09:00-18:00, Poster Session, P01-07b, Category 07b: Viral Hepatitis B & D: Clinical (except therapy), Poster Area

StephenW

背景和目的：B型肝炎e抗原（HBeAg）阴性慢性乙型肝炎病毒（HBV）感染的无效和有​​效的阶段被诊断为血清HBV DNA水平，截止2000 IU / mL的。然而，在一个单一的时间点，因为频繁波动在后一组的HBV DNA水平，是很难分辨的非活动性携带者HBeAg阴性慢性乙型肝炎患者。因此，我们的目标是建立确定“真正的非活动性携带者”治疗初治C基因型HBV感染的患者中，血清乙肝表面抗原（HBsAg）的作用。
方法：共133例HBeAg阴性携带者血清HBV DNA水平<2000 IU / mL和正常的谷丙转氨酶水平进行了登记，并随访12个月。基线临床特征，HBsAg定量，使用ARCHITECT检测，血清HBV DNA水平和生化因素进行了审查。
结果：36例（27％）表明HBV再激活（HBV DNA≥2000 IU / mL）的12个月期间从入学。基线血清HBsAg水平与HBV DNA水平与HBV再激活（均为P <0.001）。坚持非活动性携带者确定疗效的预测是的最高相结合的HBV DNA和HBsAg，HBV DNA和HBsAg（AUROC = 0.784，0.735和0.722，P均<0.001）。不过，基线血清HBV DNA水平与100％的特异性识别非活动性携带者，而基线血清HBsAg水平（49.45 IU / mL）中，两个（125 IU / mL和332国际单位/毫升）真正的非活动性携带者相结合的100％特异性和检出率的27.8％，30.9％，分别。检出率增加，不同HBsAg截止时的水平，适用于不同年龄组的平均年龄（46岁）。也进行了比较，青年组和老年组（37.2％对35.2％），即使乙肝表面抗原截止前（488 IU / ml和49.45 IU / mL）的水平增加。此外，没有发生HBV再激活时，在长期的后续应用这些截止水平。
结论：在一个单一的时间点的基线血清HBsAg水平可以识别坚持真正的非活动性携带者，根据年龄不同的截止水平。因此，频繁的监测可能是不必要的，低病毒血症患者的基线血清HBsAg水平低于这些截止水平，考虑到成本和发病率较低的疾病进展。

jndkbdzl

谢谢，看了个是懂非懂。是不是“基线血清HBsAg水平低”，HBeAg阴性携带者血清HBV DNA水平<2000 IU / mL者，能较好的保持DNA低水平？

StephenW

回复 jndkbdzl 的帖子

最好预测"坚持非活动性"HBeAg阴性携带者是用HBVDNA水平+HBsAg的水平, 其次是HBVDNA水平, 最后是HBsAg的水平.
HBVDNA水平+HBsAg的水平: HBVDNA < 125 IU/mL + HBsAg <332 IU/mL
HBsAg水平: HBsAg < 49.45 IU/mL (老年组)
                 HBsAg < 488 IU/mL (年轻组)

(这是我最好的诠释)

jndkbdzl

回复 StephenW 的帖子

"HBeAg阴性携带者是用HBVDNA水平+HBsAg的水平,"OK!