APASL2013 血清HBsAg水平可以区分e抗原阴性慢性肝炎和低复

StephenW

Serum HBsAg Levels in Treatment Naive Chronic Hepatitis B Can Differentiate between e Antigen Negative Chronic Hepatitis and Low Replicators  
     
Jeyamani Ramachandran1, Mohammad Ismail2, Gaurav Chawla1, John Fletcher2, Ashish Goel1, K.G. Sajith1, Priya Abraham2, C.E. Eapen1
1Hepatology, 2Clinical Virology, Christian Medical College, Vellore, India

Background: Chronic hepatitis B is a dynamic disease which warrants periodic monitoring for viral reactivation with DNA levels.
Aims: To determine serum HBsAg levels in various groups of treatment naive chronic hepatitis B (CHB) and cirrhosis and study the correlation between this, HBeAg status and HBV DNA levels.
To see if HBsAg levels can distinguish between low replicators and e antigen negative CHB.
Methods: 181 patients (131CHB ,50 cirrhotics) were studied. HBeAg positive CHB was classified into Immune tolerant(IT=17) and Immune clearance (IC=14) based on ALT cut off 40 IU/ml. HBeAg negative CHB were classified into Low replicators (LR, 65),E-ve chronic hepatitis (ENH, 35) based on DNA 2000 IU/l. HBsAg titres by Architect chemiluminescent system, Abbott, DNA loads by HBV real-time PCR and serum ALT were compared between the groups.
Results: Median HBsAg levels were different in the subgroups of CHB (IT- 4.14, IC-3.46, LR-3.72, ENH-4.01 log10 IU/ml ,p< .001). In cirrhotics, HBsAg levels were the lowest (3.46 log10 IU/ml) but DNA levels were higher than LR ( 3.6 Vs 2 log10 IU/ml, p< 0.001). Correlation between HBsAg and DNA was modest in HBeAg positive ( ρ 0.47, p< 0.001) group. This group was younger (26 Vs 36 yrs,p< 0.001) had higher DNA ( 7.89 Vs 2.69 log10 IU/ml, p< 0.001) ,higher HBsAg levels (4.60 Vs 3.85 log10 IU/mlp< 0.001) and higher ALT(39.50 Vs 26.50IU/ml, p< 0.01) compared to HBeAg negative patients. In HBeAg -ve patients, HBsAg level was useful in diagnosing ENH (AUROC : 0.629,p =0.03) with a sensitivity of 80% at 3.4 log10 IU/ml.
Conclusions: Serum HBsAg levels show modest correlation with DNA levels in HBeAg positive patients. In HBeAg negative patients, higher levels predict ENH status as compared to LR. This may be a good screening test in identifying patients whose DNA levels need to be monitored closely.


Assigned speakers:
Dr. Jeyamani Ramachandran, Christian Medical College , Vellore , India

Assigned in sessions:
07.06.2013, 08:30-17:30, PT-4, HEP B Clinical, Exhibition Hall

StephenW

背景：慢性乙型肝炎是一个动态的疾病，值得病毒再活化与DNA水平的定期监测。
目的：为了确定天真治疗慢性乙型肝炎（CHB）和肝硬化各组的血清HBsAg水平和学习之间的相关性，HBeAg的状态和HBV DNA水平。
要查看是否可以区分HBsAg水平低的复制和e抗原阴性CHB。
方法：181例（131CHB，50例肝硬化患者）进行了研究。 HBeAg阳性慢性乙型肝炎分为免疫耐受（IT = 17）和，免疫间隙（IC = 14）40国际单位/毫升上ALTcut关闭。 HBeAg阴性慢性乙型肝炎患者分为低复制（LR，65），E-VE慢性的肝炎（ENH 35）基于对DNA 2000 IU / L的。建筑师化学发光系统，雅培，DNA载量HBV实时PCR和血清ALT，HBsAg滴度的组间比较。
结果：HBsAg水平中位数分别为不同的亚组慢性乙型肝炎（IT-4.14，IC-3.46，LR-3.72，ENH-4.01 log10的国际单位/毫升，P <0.001）。在肝硬化患者中，HBsAg水平最低（3.46 log10的国际单位/毫升），但DNA水平高于LR（3.​​6 VS 2个log10 IU /毫升，P <0.001）。乙肝表面抗原和DNA之间的相关性是适度的HBeAg阳性组（ρ0.47，P <0.001）。这组年轻的（26和36岁，P <0.001），有较高的DNA（7.89比2.69 log10的国际单位/毫升，P <0.001），HBsAg水平较高（4.60比3.85 log10的IU /，MLP <0.001）和较高的ALT（39.50 VS 26.50IU/ml，P <0.01）相比，HBeAg阴性患者。大三阳-VE患者中，HBsAg水平是有用的ENH诊断的敏感性为80％，在3.4 log10的国际单位/毫升（AUROC：0.629，P = 0.03）。
结论：血清HBsAg水平与HBeAg阳性患者的DNA水平呈温和相关。在HBeAg阴性患者，更高水平预测ENH状态相比LR。这可能是一个很好的筛选试验，在确定需要密切监测患者的DNA水平。