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标题: EASL2015:乙型肝炎表面抗原和DNA水平可以识别非活动性携带者 [打印本页]

作者: StephenW    时间: 2015-4-15 09:22     标题: EASL2015:乙型肝炎表面抗原和DNA水平可以识别非活动性携带者

本帖最后由 StephenW 于 2015-4-15 09:22 编辑

RS-2626
Viral hepatitis
Hepatitis A, B, D E Clinical (Except Therapy)




HEPATITIS B SURFACE ANTIGEN AND DNA LEVELS CAN IDENTIFY INACTIVE CARRIERS AND PREDICT LOWER RISK FOR HEPATOCELLULAR CARCINOMA AND CIRRHOSIS AMONG GENOTYPE B AND C CHRONIC HEPATITIS B CARRIERS
Jessica Liu* 1, Hwai-I Yang1, Mei-Hsuan Lee2, Richard Batrla-Utermann3, Chin-Lan Jen1, Sheng-Nan Lu4, Li-Yu Wang5, San-Lin You1, Chien-Jen Chen1
1Academia Sinica Genomics Research Center, 2Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, 3Roche Diagnostics, Basel, Switzerland, 4Gastroenterology, Chang-Gung Memorial Hospital, Kaohsiung, 5MacKay College of Medicine, Taipei, Taiwan


Corresponding author’s email: [email protected]


Background and Aims:
Inactive chronic hepatitis B virus (HBV) carriers have significantly decreased risk for hepatocellular carcinoma (HCC) and liver cirrhosis, and are more likely to reach HBsAg seroclearance. Differentiation between inactive and active carriers is crucial to identifying those in need of more stringent follow-up. Previous studies showed that a single point measurement of HBV DNA and HBsAg levels could identify inactive carriers in genotype D carriers. This study aims to validate these previous findings in genotype B and C carriers, and also examines rates of HCC, cirrhosis, and HBsAg seroclearance among those identified as inactive carriers using a single measurement.
Methods:
1526 HBeAg-negative individuals from the REVEAL-HBV cohort were included in this study. Participants were anti-HCV seronegative and free of cirrhosis at study entry. To identify inactive and active carriers, all participants had at least two to three measurements of HBV DNA / ALT within 1.5 years of study entry. Hazard and rate ratios of outcomes were estimated using Cox proportional hazards models.
Results:
Within 1.5 years, 775 (51%) were inactive carriers (IC) with HBV DNA persistently <10,000 copies/mL, 496 (33%) were active carriers (AC) with periodic HBV DNA elevations <100,000 copies/mL, and 255 (17%) were highly replicative active carriers (HRAC) with HBV DNA fluctuating or persisting above 100,000 copies/mL. The proportion of abnormal ALT elevations (>40 U/L) was 0%, 9%, and 20% for IC, AC, and HRAC, respectively. A single point measurement of HBsAg <1000 iu/mL and HBV DNA <10,000 copies/ml could identify IC with a sensitivity, specificity, positive predictive value, and negative predictive value of 0.71, 0.85, 0.83, 0.74, respectively, and 0.71, 0.91, 0.96, 0.51, respectively, when limited to IC and HRAC only. The same single point measurement also identified individuals with significantly lower risk of HCC and cirrhosis, with adjusted hazard ratios (95% CI) of 0.20 (0.08-0.51) and 0.27 (0.14-0.50), respectively. Rates of HBsAg seroclearance were also much higher, with an adjusted rate ratio (95% CI) of 7.14 (5.62-9.09).
Conclusions:
Compared with long-term determination, a single point combined measurement of HBsAg and HBV DNA is able to identify inactive carriers with moderate accuracy, while also differentiating those with reduced risk for HCC and cirrhosis, and higher probability of HBsAg seroclearance.


Disclosure of Interest: J. Liu: : None Declared, H.-I. Yang: : None Declared, M.-H. Lee: : None Declared, R. Batrla-Utermann:  Employee: Roche Diagnostics, C.-L. Jen: : None Declared, S.-N. Lu: : None Declared, L.-Y. Wang: : None Declared, S.-L. You: : None Declared, C.-J. Chen: : None Declared








                                                        





        

作者: StephenW    时间: 2015-4-15 09:23


RS-2626

病毒性肝炎

A型肝炎,B,D E临床(除治疗)





乙型肝炎表面抗原和DNA水平可以识别非活动性携带者和预测风险较低的肝癌和肝硬化中B,C基因型慢性乙肝携带者

杰西卡刘* 1,Hwai-I杨1,梅轩Lee2,理查德Batrla-Utermann3,金澜Jen1,盛楠LU4,李渝Wang5,圣林You1,建仁臣1

1Academia中央研究院基因组学研究中心,临床医学2中国科学院,国立阳明大学,台湾台北,3Roche诊断,瑞士巴塞尔,4Gastroenterology,长庚纪念医院,高雄医学大学5MacKay,台北,台湾



通讯作者的邮箱:[email protected]



背景和目的:无效的慢性乙型肝炎病毒(HBV)携带者有风险肝细胞癌(HCC)和肝硬化显著下降,更容易达到乙肝表面抗原转阴。不活跃和积极的运营商之间的差异是非常重要的识别那些需要更严格的随访。以往的研究表明,HBV DNA和HBsAg水平的单点测量能够确定在D基因型载波不活动载波。这项研究的目的是验证这些以前的研究结果在B,C基因型携带者,并且还考察了在那些使用单一的测量确定为不活动载体肝癌,肝硬化,与HBsAg血清学清除率。

方法:1526例HBeAg阴性个体从REVEAL-HBV队列被列入这项研究。与会者抗HCV阴性和免费性肝硬化的研究项目。以确定非活动和活动载波中,所有参与者在1.5年的研究项中的至少两到三个测量HBV DNA / ALT的。使用Cox比例风险模型估计结果的风险和速度比率。

结果:在1.5年中,775(51%)是不活动的携带者(IC)与HBV DNA持续<10,000拷贝/毫升,496(33%)为有效载波(AC)定期HBV DNA升高<10万份/毫升,和255(17%)为高复制活跃的运营商(HRAC)与HBV DNA波动或持续高于10万份/毫升。 ,异常ALT升高的比例(> 40U / L),分别为0%,9%,20%为集成电路,AC和HRAC分别。乙肝表面抗原<1000 IU / mL和HBV DNA <10000份的单点测量/ ml的能够识别IC具有敏感性,特异性,阳性预测值,并且,0.71阴性预测值为0.85,0.83,0.74,分别为0.71, 0.91,0.96,0.51,分别当限于集成电路和HRAC只。相同的单点测量还确定与肝癌0.20(0.08-0.51)和0.27(0.14-0.50)显著风险较低和肝硬化,与调整后的危险比(95%CI)的个人,分别。乙肝表面抗原的转阴率也高得多,与7.14(5.62-9.09)调整的速度比(95%CI)。

结论:长期测定,乙肝表面抗原和HBV DNA能够识别不活动载波具有中等精度,同时还区分那些与肝癌和肝硬化的风险降低了单点组合测定,与HBsAg血清清除的可能性更高相比。



股权变动:J.刘:无申报,H.-I.杨:无申报,M.-H.李:无申报,R. Batrla-Utermann:员工:罗氏诊断,C.-L.仁:无申报,S.-N.鲁:无申报,L.-Y.王:无申报,S.-L.您:无申报,C.-J.陈:无申报
作者: 战天斗hbv    时间: 2015-4-15 13:26

好文!感谢分享!
作者: x321    时间: 2015-4-15 14:32

没查过表抗多少,病毒7次方应该表抗也很高吧?
作者: 战天斗hbv    时间: 2015-4-15 16:36

x321 发表于 2015-4-15 14:32
没查过表抗多少,病毒7次方应该表抗也很高吧?

是、
你以前查的五项都是定性的吗?hbsag定量是非常重要的数据、具有指导作用、这种定量检测也是近年来才能做到的、所以不要老是说科学没有进步哦
作者: x321    时间: 2015-4-15 17:43

回复 战天斗hbv 的帖子

我也是最近几个月突然查出大三阳,下次复查弄清楚来,千万不要像病毒这样多
作者: x321    时间: 2015-4-15 17:51

之前一直把表抗和e抗原搞反了,以为联合治疗有30%的治愈率,这两天才恍然大悟,打击呀
作者: 战天斗hbv    时间: 2015-4-15 18:41

x321 发表于 2015-4-15 17:51
之前一直把表抗和e抗原搞反了,以为联合治疗有30%的治愈率,这两天才恍然大悟,打击呀 ...

这里的治愈指的临床治愈吧、倒也没错、没有任何恶意、但是建议你不要对你的表抗数据抱有太大期望、毕竟你的dna数据很高、
作者: x321    时间: 2015-4-15 18:54

回复 战天斗hbv 的帖子

最要命我还在携带,耐受到什么时候不知道,是啊,应该是很高,我查应该没什么期望的,主要是肝功能不正常才开始查来作药效依据吧
作者: 四十己过    时间: 2015-4-15 19:03

100IU S原以下自愈的可能性最大    5000降到2000IU,速度最快,分界线10000IU 以上算高。 忘了哪看到的,仅供参考
作者: x321    时间: 2015-4-15 19:07

回复 四十己过 的帖子

又知道多了一点




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