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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
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发表于 2015-4-15 09:22
