HBV杂志回顾 2013年7月1日 M. Kukka恭

StephenW

Experts Describe When to Treat Pregnant Women with Antivirals
Two U.S. hepatitis B experts have crafted guidelines for doctors to use when deciding when to treat pregnant women infected with the hepatitis B virus (HBV) with antivirals in order to safeguard the women's health and prevent infection of newborns.

More than half of new hepatitis B infections result from mother-to-child (vertical) transmission and despite immediate immunization and administration of HBIG (hepatitis antibodies), about 30% of infants born to women with high viral loads become infected. Additionally, women who want to become pregnant may already be treated with antivirals because of liver damage.  There is little medical guidance on whether treatment is safe over the entire pregnancy.

Does pregnancy worsen hepatitis B? Generally it does not unless the woman has cirrhosis (severe liver scarring.) Studies show a pregnant woman's viral load generally does not increase over a pregnancy, but after the baby is born and the woman's hormone levels change (akin to a sudden decline in steroids), some women experience a "flare" and their alanine transaminase (ALT) levels may increase due to moderate liver cell damage. Because of these flares, doctors must monitor new mothers carefully for several weeks after childbirth.

When should pregnant women be treated? Starting in the second or third trimester of pregnancy, antiviral treatment is recommended when women have high viral loads—exceeding 1 million copies per milliliter or 200,000 international units per milliliter. However, if women are already receiving antiviral treatment when they become pregnant, treatment should probably continue over the pregnancy to prevent worsening liver disease.

Which antivirals are safe to use during pregnancy? The experts recommend tenofovir (Viread) in the event the woman continues to need antiviral treatment because this drug has a very low rate of drug resistance, or telbivudine (Tyzeka). Both have been shown to be safe and cause no birth defects when used in pregnant women infected with HIV or HBV.

What if women have elevated ALTs before becoming pregnant and have never been treated? The experts recommend these women should be treated with antivirals (not interferon), and if possible their viral load should be reduced through antiviral treatment before becoming pregnant. Their liver health should be monitored carefully during the pregnancy.

What about women with normal ALTs and high viral loads? Women in this immune-tolerant phase of infection should be monitored carefully during pregnancy and should be given antivirals during their second or third trimester if they:

    Continue to have viral loads exceeding 1 million copies per mL
    Have already had a child who became HBV-infected
    Or if they experience premature labor.

Is it safe to use antivirals during the entire pregnancy? If women have been using antivirals, or require treatment because of liver damage (ALT flares) during pregnancy, antivirals should be used to safeguard the women's health, according to the report published in the June issue of Seminars in Liver Disease. They recommend using tenofovir in this situation, because it is fast-acting, potent, and has no record of causing birth defects.

Monitoring after delivery: Because of the risk of hepatitis flares after delivery, and after treatment stops following delivery, the new mother should be monitored every four to six weeks for at least 12 weeks after antiviral treatment stops.

Can a woman taking antivirals breastfeed? Trace amounts of the antiviral have been found in breast milk, so experts do not recommend breastfeeding if antiviral treatment is ongoing.

Source: "Antiviral therapy for chronic hepatitis B in pregnancy" by Pan and Lee.Semin Liver Dis. 2013 May;33(2):138-46.
www.ncbi.nlm.nih.gov/pubmed/23749670

StephenW

专家形容当与抗病毒药物治疗孕妇
两名美国乙肝专家已经制作指引，让医生决定何时与B型肝炎病毒（HBV）感染的抗病毒药物，以保障妇女的健康，防止新生儿感染治疗孕妇时使用。

超过一半新的乙肝感染源于母亲对孩子（垂直）传输，尽管立即免疫接种和管理的乙肝免疫球蛋白（丙型肝炎抗体）与病毒载量高的妇女所生婴儿中，约有30％被感染。此外，女性想怀孕的人可能已经被视为与抗病毒药物，因为肝功能损害。很少有医生指导治疗是否安全在整个怀孕。

是否怀孕恶化乙肝吗？一般来说它不不，除非女人有肝硬化（严重肝疤痕。）研究表明孕妇的病毒负荷一般并不会增加超过怀孕，但后宝宝的出生和女人的激素水平改变（类似于类固醇突然下降），有些妇女经历一个“喇叭形”和丙氨酸转氨酶（ALT）水平可能增加，因为中度肝细胞损害。由于这些耀斑，医生必须仔细监测新妈妈在分娩后的几个星期。

当孕妇应该如何治疗？在第二次或第三次妊娠晚期开始，抗病毒治疗时，建议妇女具有较高的病毒载量超过100万份，每毫升或每毫升20万国际单位。但是，如果妇女已经接受抗病毒治疗时，他们变得​​怀孕，治疗应该继续在怀孕，防止肝病恶化。

哪些抗病毒药物是安全的，在怀孕期间使用吗？专家建议诺福韦（Viread的）事件中的女人，仍然需要抗病毒治疗，因为这种药物具有非常低的耐药率，或替比夫定（Tyzeka）的。已被证明是安全的，不会引起出生缺陷，使用时，孕妇感染艾滋病毒或HBV。
如果妇女在怀孕前有升高的低价竞标，从来没有受到过什么？专家们建议，这些妇女应与抗病毒药物（干扰素）治疗，如果可能的话，通过抗病毒治疗在怀孕前应该减少他们的病毒载量。在怀孕期间，应仔细监测其肝脏健康。
关于妇女与正常的低价竞标和高病毒载量是什么？在怀孕期间感染这种免疫耐受期的妇女应仔细监测，如果他们在他们的第二或第三孕期应该给予抗病毒药物：

    继续有病毒载量超过100万份，每毫升
    已经有一个孩子，谁成为HBV感染
    或者，如果他们遇到早产。

它是安全，在整个妊娠期间使用抗病毒药物？如果妇女已经使用抗病毒药物，或需要治疗，因为在怀孕期间肝功能损害（ALT升高），抗病毒药物应使用，以保障妇女健康，根据报告发表在6月发行的研讨会在肝脏疾病。他们建议在这种情况下，使用替诺福韦，因为它是作用迅速，有力，有没有记录，造成出生缺陷。


分娩后的监测：由于分娩后肝炎爆发的风险，及治疗后停止交付后，新妈妈应监测，每四到六周至少12周的抗病毒治疗后停止。

一个女人服用抗病毒药物可以哺乳吗？已在母乳中发现微量的抗病毒药物，因此专家不建议母乳喂养，如果正在进行抗病毒治疗。

资料来源：“怀孕”潘Lee.Semin肝病治疗慢性乙型肝炎的抗病毒治疗。 5月2013，33（2）:138-46。
www.ncbi.nlm.nih.gov/pubmed/23749670

StephenW

Half of Patients Treated Long-Term with Tenofovir Lose HBeAg
After more than five years of tenofovir treatment, 50% of patients lose the hepatitis B "e" antigen (HBeAg), 37% seroconvert and develop "e" antibodies, 11% lose the hepatitis B surface antigen (HBsAg), and 8% clear the infection and develop surface antibodies, according to a global study presented at the 23rd Conference of the Asian Pacific Association for the Study of the Liver held in early June.

This and several other studies on tenofovir presented at APASL provided strong proof that tenofovir appears to be highly effective in reducing viral replication with 96% of patients reporting reduced (or no worsening) fibrosis and all achieving undetectable viral load. Even 74% of patients with cirrhosis were no longer cirrhotic after five years of treatment.

Long-term antiviral use has been associated with bone loss and kidney damage, but neither symptom was evident among the patients over the lengthy study period.

In another APASL study, researchers monitored 280 patients who had developed drug resistance to the antiviral lamivudine (Epivir-HBV) to see if they developed resistance when treated with tenofovir (alone or in combination with emtricitabine).

After 96 weeks of treatment, researchers reported that all patients responded well and no drug resistance developed. Tenofovir was successful in stopping viral replication even among virus that had mutated and had been able to "resist" lamivudine.

Source 1: "Six years of treatment with tenofovir..." by Tsai, Buti, Gane et al. APASL Liver Week. Singapore, June 6-10, 2013
www.natap.org/2013/APASL/APASL_30.htm

Source 2: No detectable tenofovir resistance..." by Gane, Corsa, Liu et al. APASL Liver Week. Singapore, June 6-10, 2013
www.natap.org/2013/APASL/APASL_31.htm



Even Patients with High Viral Loads Lose HBeAg with Tenofovir
Half of 10 HBeAg-positive patients with extremely high HBV DNA (exceeding 1 million copies/mL) who were treated with tenofovir over five years (288 weeks) lost HBeAg, 40% developed “e” antibodies, and 72.7% achieved normal ALT levels.

This study is significant because current medical guidelines do not recommend treating patients in the “immune-tolerant” stage of infection—when viral load is high and ALT levels are only slightly elevated.

This study focused on younger Asian adults (average age 32), two-thirds of whom were male. Their results were compared with 172 patients with lower viral loads who were also treated with tenofovir over 288 weeks. The group with lower viral loads achieved undetectable HBV DNA faster (within 60 weeks) while patients with high viral loads took 88 weeks to achieve undetectable HBV DNA.

Tenofovir’s success in spurring HBeAg seroconversion in younger adults—which usually results in a permanent lowering of viral load—may force experts to reconsider whether to change practice guidelines and recommend treating this patient group.

However, the next challenge experts must tackle is how long to treat this younger patient group with antivirals in order to achieve a sustained, permanent HBeAg seroconversion.

Source: “Tenofovir Disoproxil Fumarate (TDF) in Asian…” by Fung, Gordon, Krastev et al. 23rd Conference of the Asian Pacific Association for the Study of the Liver, 6-9 June 2013, Singapore.
www.natap.org/2013/APASL/APASL_28.htm

一半的患者长期治疗泰诺福韦失去大三阳
经过五年多的替诺福韦治疗，50％的患者失去乙肝“e”的抗原（HBeAg），37％的血清转化和发展的“e”抗体，11％失去了乙肝表面抗原（HBsAg），和8％清除感染和发展表面抗体，根据一项全球性研究，提出了在亚太协会第23届会议在六月初召开的肝的研究。

APASL替诺福韦这和其他几个研究提供了有力的证明，替诺福韦似乎是高度有效地减少病毒的复制，96％的患者减少纤维化，全部实现了病毒载量检测不到（或没有恶化）。即使74％的肝硬化患者不再肝硬化的治疗五年后。

已经长期应用抗病毒药物相关的骨质流失，肾脏损害，但在漫长的研究期间患者之间既不症状明显。

在另一个APASL研究中，研究人员监测了280例谁开发耐药抗病毒药拉米夫定（拉米HBV）的，看看他们是否产生抗药性时，替诺福韦治疗（单独或联合恩曲他滨）。

治疗96周后，研究人员报告说所有的患者反应良好，无耐药性开发。泰诺福韦是成功阻止病毒复制，即使在病毒突变，已经能够“抵抗”拉米夫定。

来源：“六十年替诺福韦治疗......”布提，蔡甘恩等。 ，APASL肝周。新加坡，2013年6月6-10日
www.natap.org/2013/APASL/APASL_30.htm

源2：没有检测替诺福韦电阻...“由甘恩，科萨，柳等。APASL肝周，新加坡，2013年6月6-10日
www.natap.org/2013/APASL/APASL_31.htm



即使具有高病毒载量的患者失去大三阳泰诺福韦
10例HBeAg阳性患者HBV-DNA具有极高（超过100万拷贝/ ml）分别用替诺福韦超过五年（288周）的一半失去了大三阳，40％开发的“e”的抗体，并取得72.7％ALT水平正常。

此研究是重要的，因为目前的医疗指引不建议在“免疫耐受”的阶段感染患者治疗时病毒载量和ALT水平仅轻度增高。

这项研究主要集中在年轻的亚洲成年人（平均年龄32岁），其中三分之二为男性。他们的研究结果相比，有172例患者病毒载量较低，谁也替诺福韦治疗288周。病毒载量较低的组更快达到HBV DNA检测不到（后60周），同时具有高病毒载量的患者花了88周达到HBV DNA检测不到。

泰诺福韦的成功，促使HBeAg血清转换在年轻的成年人，这通常会导致一个永久性降低病毒载量，可能会迫使重新考虑是否要改变实践指南和建议治疗这个病人组的专家。

然而，专家们必须解决的下一个挑战是如何看待这个年轻患者使用抗病毒药物，以达到持续的，永久的HBeAg血清转换。

资料来源：“替诺福韦酯富马酸（TDF）在亚洲......”由丰，戈登，克勒斯特夫等。第23届亚太肝脏研究协会，2013年6月6日至9日，新加坡会议。
www.natap.org/2013/APASL/APASL_28.htm

StephenW

New Type of Interferon Effective in Phase 2 Hepatitis B Trial
A new type of pegylated interferon, called peginterferon Lambda, reduced viral load (HBV DNA) and hepatitis B surface antigen (HBsAg) levels faster than the standard pegylated interferon alfa-2a (Pegasys), according to results from a Phase 2 clinical trial presented at the APASL conference.

Eighty patients (most Asian and male) were given the weekly Lambda injections for 24 weeks in the ongoing study and 83 patients were treated with the standard interferon. The patients' ages ranged from 18 to 70 and half of the study participants had only moderately elevated ALT levels.

After the first 24 weeks covered by this study, both interferons appeared equally effective in spurring HBeAg loss. Surprisingly, the conventional interferon was better at reducing ALT levels to normal ranges (33.7% vs. 23.8% in the Lambda group.) There were no safety concerns or additional side effects resulting from Lambda treatment compared to the standard interferon.

Lambda interferon has proven effective in hepatitis C clinical trials, where it reportedly causes fewer flu-like side effects. The hepatitis B Lambda study is ongoing, with a goal of 48 total weeks of treatment followed by 164 weeks of follow-up.

Source: "Peginterferon Lambda for the Treatment of ..." by Chan, Ahn, et al.
APASL Liver Week. Singapore, June 6-10, 2013
www.natap.org/2013/APASL/APASL_16.htm

在第2阶段乙型肝炎试用新型干扰素有效
一种新型的聚乙二醇干扰素，聚乙二醇干扰素拉姆达，降低病毒载量（HBV-DNA）和乙肝表面抗原（HBsAg）水平速度比标准的聚乙二醇化干扰素α-2a（派罗欣），从第2阶段临床试验结果在APASL会议的。

80例（大多数亚洲和男性），连续24周每周注射拉姆达正在进行的研究，并与标准干扰素治疗83例。患者的年龄从18到70不等，有一半的研究参与者只有中等程度的ALT水平升高。

属于这项研究的第24周之后，出现两种干扰素同样有效刺激HBeAg消失。令人惊讶的是，常规干扰素更好地降低ALT水平在正常范围内（33.7％比23.8％的Lambda组）有没有安全问题的或额外的副作用相比，标准干扰素从拉姆达治疗所导致。

拉姆达干扰素在丙型肝炎的临床试验已证明是有效的，据报造成较少的流感样副作用。乙肝拉姆达的研究正在进行中，同一个目标，共48周的治疗164周的随访。

资料来源：“聚乙二醇干扰素拉姆达待遇......”陈，安贞焕等。
，APASL肝周。新加坡，2013年6月6-10日
www.natap.org/2013/APASL/APASL_16.htm

StephenW

Majority of Hepatitis B Patients Have Vitamin D Deficiency
Researchers know that people with hepatitis C and other types of liver disease have vitamin D deficiency, but little is known as to whether people with HBV infection also lack this vitamin, which is essential for strong bones and immune systems.

A group of global researchers measured vitamin D levels in 735 patients with active HBV infection just before they joined a clinical trial. They found that:

    Only 7% of the patients had healthy vitamin D levels
    35% had relatively insufficient vitamin D levels
    And 58% were deficient (with less than 20 ng/mL of vitamin D in their systems.)

Vitamin D levels did rise in patients who were living in sunny, warm climates. Sunlight spurs the body to generate vitamin D.

Their findings mirror smaller studies that found hepatitis B patients with liver disease had lower vitamin D levels. This study was presented at APASL.

Source: "High Prevalence of Vitamin D Deficiency...." by Alkashab, Foster, Kim et al. APASL Liver Week. Singapore, June 6-10, 2013
www.natap.org/2013/APASL/APASL_27.htm



Patients with Healthy Vitamin D Levels Are More Likely to Clear HBsAg
Israeli researchers found that hepatitis B patients who had healthy vitamin D levels were more likely to clear HBsAg and achieve "inactive" hepatitis B than those with vitamin D deficiency, according to a report published in the June issue of the World Journal of Hepatology.

They followed 53 patients who lost HBsAg between 2007 and 2012 and found that 83% of those who cleared the virus had normal vitamin D levels. Patients who lost HBsAg also had lower viral loads and were HBeAg-negative.

Source: “Normal Vitamin D Levels…” by Mahamid, Nseir, Elhija et al. World J Hepatol. 2013 Jun 27;5(6):328-331.
www.ncbi.nlm.nih.gov/pubmed/23805357

大部分乙肝患者有维生素D缺乏症
研究人员知道，丙型肝炎和其他类型的肝脏疾病的人有维生素D缺乏症，但很少被称为乙肝病毒感染的人是否也缺乏这种维生素，这是强健骨骼和免疫系统至关重要。

A组的全球研究人员测量活动性HBV感染的735例患者中维生素D水平之前，他们参加临床试验。他们发现：

    只有7％的患者有健康的维生素D水平
    35％有相对不足的维生素D水平
    和58％不足（少于20毫微克/毫升的维生素D在他们的系统。）

维生素D水平没有上升，那些生活在阳光明媚，气候温暖的患者。阳光刺激机体产生维生素D。

他们的研究结果反映较小的研究发现乙肝肝病患者的维生素D水平较低。这项研究提出了APASL。

资料来源：“维生素D缺乏症的高患病率......”由Alkashab，福斯特，金等。 ，APASL肝周。新加坡，2013年6月6-10日
www.natap.org/2013/APASL/APASL_27.htm



与健康的维生素D水平的患者更有可能清除乙肝表面抗原
以色列研究人员发现，乙肝患者有健康的维生素D水平，更容易清除HBsAg和实现“不活跃”的乙肝比那些与维生素D缺乏症，根据世界中华肝脏病杂志六月号发表的一份报告。

他们随访了53例患者在2007年和2012年之间，谁失去了乙肝表面抗原，并发现，那些谁清除的病毒有83％以上的正常的维生素D水平。谁失去了乙肝表面抗原的患者也有降低病毒载量和HBeAg阴性。

资料来源：“正常的维生素D的水平......”由Mahamid，Nseir Elhija等。世界肝。 2013年6月27，5（6）:328-331。
www.ncbi.nlm.nih.gov/pubmed/23805357

StephenW

Activists Develop a National Plan to Eradicate Hepatitis B in the U.S.
An estimated 2 million Americans are infected with hepatitis B and two-thirds do not know it. Screening and treatment of those chronically-infected remains poor with fewer than 10% getting the treatment they need. To make matters worse, many of those infected are immigrants or first-generation Asian-Americans who face overwhelming cultural and financial barriers to getting diagnosed, immunized or treated.

To address this glaring health disparity, the Hepatitis B Foundation convened a team of experts and community activists from across the country to develop strategies to break down cultural barriers and educate medical providers and patients to address this challenge.

According to a report in the May issue of the Journal of Community Health, the summit generated the "Hep B United" Campaign with the following goals:

    Bolster and strengthen community groups and coalitions to raise awareness about hepatitis B and the benefits of testing and treatment and immunization as a key prevention strategy.
    Educate patients so they demand HBV testing, even when their medical providers are uninformed about the infection.
    Decrease community stigma and discrimination associated with hepatitis B.

To tackle provider ignorance and inaction, organizers urged government health care monitoring groups to evaluate doctors based on their hepatitis B screening, immunizing and treatment scores. They also encouraged use of electronic medical records to promote better provider adherence to current hepatitis B screening and treatment guidelines.

Educating providers and developing case management strategies so HBV-infected pregnant women had access to monitoring, treatment and other safeguards to prevent infection of their newborns was also recommended. Similar case management practices are now used when pregnant women are found to be HIV-infected to ensure treatment and prevention.

Striking down cultural barriers was also deemed essential, which requires more than simply translating English materials into new languages. The materials must be developed by native speakers, according to the group, who understand the nuances of culture and language of individual ethnic groups.

"Building upon the current national focus on prevention and treatment of viral hepatitis, the Hep B United community action plan is designed to be a national resource for local HBV coalitions across the country as they strive to meet the health needs of their communities and eliminate HBV-related health disparities," the coordinators wrote.

Source: "Eradication of Hepatitis B...," by Cohen, Caballero, Martin et al.
J Community Health. 2013 May 29.
www.ncbi.nlm.nih.gov/pubmed/23715963

活动家制定一个国家计划，以消除B型肝炎在美国
估计有200万美国人感染了乙肝和三分之二不知道它。慢性感染的筛查和治疗的不到10％得到他们所需要的治疗仍然不佳。更糟的是，许多感染者是移民或第一代亚裔美国人面对铺天盖地的文化和金融障碍诊断，免疫或治疗。

为了解决这个明显的健康差距，B型肝炎基金会召集了一个专家和来自全国各地的发展战略，打破文化壁垒和教育医疗提供者和患者应对这一挑战的社会活动家。

根据在5月发行的社区卫生杂志“的一份报告，本次峰会产生的”乙肝美国“运动与以下目标：

    枕和加强社会团体和联盟，以提高认识乙肝的检测和治疗和免疫作为重点防治策略的好处。
    教育患者，所以他们要求乙肝检测，甚至当他们的医疗服务提供者不知情的感染。
    减少社区与B型肝炎相关的耻辱和歧视

为了解决供应商的无知和无所作为，组织者敦促政府医疗保健监测组评估医生根据他们的B型肝炎筛检，免疫和治疗分数。他们还鼓励使用电子病历，以促进更好的提供者坚持目前的B型肝炎筛检和治疗指南。

教育提供者和开发案件管理策略，使乙肝感染孕妇的监测，治疗和其他保障措施，以防止其新生儿感染还建议。类似的案件管理的做法，现在使用的时候怀孕的妇女被发现艾滋病毒感染者，以确保治疗和预防。

打倒文化上的障碍也被认为是必不可少的，这就需要更多的不是简单的英语翻译成新的语言材料。材料必须制定以英语为母语的人，到组，了解个别族群的文化和语言的细微差别。

“建立在当前国家重点预防和治疗病毒性肝炎，乙肝联合社区行动计划的设计是一个国家的资源为当地HBV全国各地的联盟，因为他们努力满足他们的社区的健康需求，并消除HBV相关的健康差距，“协调员写道。

资料来源：“消除B型肝炎，”科恩，卡瓦列罗，马丁等人。
Ĵ社区卫生服务。 2013年5月29。
www.ncbi.nlm.nih.gov/pubmed/23715963

StephenW

New Guidelines Urge Britain's Doctors to Improve Hepatitis B Care
The National Institute for Health and Care Excellence (NICE), which develops medical practice guidelines for Britain's National Health Service, has found that its general practitioners are failing to adequately treat patients with hepatitis B, similar to what occurs in the United States.

A recent London audit found that one-third of people with chronic hepatitis B were not referred to specialists for monitoring and treatment. In June, NICE issued new hepatitis B treatment guidelines that detail what tests should be run, and when patients should be referred to specialists for treatment.

"With multiple treatment options that are efficacious and safe, the key questions are which patients need immediate treatment and what sequence and combination of drug regimens should be used, and which patients can be monitored and delay treatment," the guidelines note.

Interestingly, the guidelines promote treating pregnant women with high viral loads with tenofovir during their third trimester of pregnancy.

Source: Hepatitis B (chronic): Diagnosis and management of chronic hepatitis B in children, young people and adults. Clinical Guideline 165. National Institute for Health and Care Excellence, Manchester. Great Britain
http://guidance.nice.org.uk/CG165

新准则敦促英国的医生，以提高乙肝护理
健康和护理卓越研究所（NICE），英国的国家卫生服务发展医疗执业准则，目前已发现的全科医生未能充分治疗的乙肝患者，类似​​发生在美国。

伦敦最近的一项审计发现，有三分之一的人患有慢性乙肝的监测和治疗的专家没有提到。今年6月，纳爱斯发行新的乙肝治疗指南，详细说明哪些测试应该运行，当患者应转介到专科医生治疗。

“随着多种治疗方案是有效和安全的，关键的问题是哪些患者需要立即治疗和药物疗法的顺序和组合，应使用，哪些病人可以监控和延误病情，”指引注。

有趣的是，指引推动高病毒负荷替诺福韦治疗孕妇期间他们孕晚期。

资料来源：乙型肝炎（慢性）：在儿童，青少年和成人慢性乙型肝炎的诊断和管理。临床指引165。国立卫生和护理卓越，曼彻斯特。大不列颠
http://guidance.nice.org.uk/CG165

StephenW

Measuring HBsAg Levels May Identify Fibrosis and Avoid Liver Biopsies
Chinese researchers have found that measuring HBsAg and the liver enzyme GGT (gamma-glutamyl transferase) can accurately identify if a person has fibrosis—and avoid the need for invasive liver biopsies.

The researchers performed liver biopsies—in which a small sliver of liver tissue was removed through a needle—on 197 HBeAg-positive patients (average age 31, most male). The doctors simultaneously measured HBsAg and GGT (a liver enzyme that is released when liver cells are damaged or die.)

The average HBsAg level in the patients was about 15,800 international units per milliliter. Researchers found significant fibrosis through their liver biopsies in 56.9% of patients with higher HBsAg levels.

They found that elevated levels of both HBsAg and GGT accurately indicated fibrosis (liver inflammation), according to the biopsies. They reported these two measurements accurately identified fibrosis in 78% of the patients, which means about 80% of liver biopsies could have been avoided in HBeAg-positive patients, according to their report published in the June issue of the Journal of Gastroenterology and Hepatology.

Source: "Serum HBsAg quantification ..." by Xun, Zang, Guo et al. J Gastroenterol Hepatol. 2013 Jun 25
www.ncbi.nlm.nih.gov/pubmed/23800140



HBsAg Levels May Also Predict Cancer Risk in HBeAg-negative Patients
In a large study of hepatitis patients, Taiwanese researchers were surprised to discover that higher levels of HBsAg increased these HBeAg-negative patients' liver cancer risk more than having high viral loads. The study was published in the May issue of the journal Gastroenterology.

Researchers followed 2,688 patients over 14 years and studied the link between HBsAg levels and liver cancer. While high viral load was a better indicator of which HBeAg-positive patients developed cancer (along with age, ALT, and gender), among HBeAg-negative patients with viral loads under 2,000 IU/mL, it was HBsAg levels that were the most important indicator.

"Among HBeAg-negative patients with low viral loads, liver cancer risk is determined by levels of HBsAg and ALT and age, but not HBV DNA," they wrote.

Source: "High levels of hepatitis B..." by Tseng, Liu, Yang et al. Gastroenterology Vol. 142, Issue 5
www.ncbi.nlm.nih.gov/pubmed/22333950

测量HBsAg水平可以识别纤维化和避免肝活检
测定HBsAg和肝酶GGT（γ-谷氨酰转移酶）中国研究人员发现，如果一个人有能准确识别纤维化，避免需要侵入肝活检的。

研究者进行肝活检的肝组织在一个小条子辗转穿过针197例HBeAg阳性患者（平均年龄31，大多数男性）。医生同时测定HBsAg和GGT（肝脏酶被释放时，肝细胞受损或死亡。）

在患者的乙肝表面抗原水平平均约15,800国际单位每毫升。研究人员发现，显着纤维化，通过肝活检在56.9％患者HBsAg水平较高的。

他们发现，HBsAg和GGT水平升高准确地标明纤维化（肝的炎症），根据活检。他们报道了这两个测量准确识别78％的患者中，这意味着大约80％的肝活检可能已经避免在HBeAg阳性患者，根据他们的报告发表在6月发行胃肠病学和肝病学杂志纤维化。

资料来源：“血清HBsAg定量...”迅，臧，郭等人。胃肠肝脏病杂志。 2013年6月25
www.ncbi.nlm.nih.gov/pubmed/23800140



HBeAg阴性患者中，HBsAg水平，还可以预测癌症风险
肝炎患者在一项大型研究，台湾研究人员惊奇地发现，较高水平的乙肝表面抗原增加这些HBeAg阴性患者的肝癌风险比具有高病毒载量。这项研究结果发表在5月份的“胃肠病学”杂志上。

研究人员随访超过14年的2,688例患者，研究HBsAg水平和肝癌之间的联系。虽然高病毒载量是最重要的一个更好的指标，其中HBeAg阳性患者患上癌症（随着年龄的增长，ALT和性别），在2,000 IU / mL的HBeAg阴性患者的病毒载量，HBsAg水平指示器。

“其中HBeAg阴性患者的病毒载量低，肝癌的危险是由HBsAg和ALT和年龄水平，但不是乙肝病毒DNA，”他们写道。

来源：高含量的“B型肝炎..”曾，柳传志，杨元庆等人。胃肠病。 142，第5期
www.ncbi.nlm.nih.gov/pubmed/22333950

咬牙硬挺

翻墙来的，感谢分享。