EASL2015:乙肝表面抗原NEGATIVIZATION在非活动预测模型 乙肝表面

StephenW

P0593
PREDICTIVE MODEL OF HBsAg NEGATIVIZATION IN INACTIVE
HBsAg CHRONIC CARRIERS, MAINLY CAUCASIAN
M.L. Gonza´ lez-Die´guez1, C.A. Navascue´ s1, G. Albines1,
Mercedes Rodr´ıguez2, V. Cadah´ıa1, M. Varela1, R. P´erez1,
Manuel Rodr´ıguez1. 1Liver Unit, 2Microbiology Department, Hospital
Universitario Central de Asturias, Oviedo, Spain
E-mail: [email protected]
Background and Aims: HBsAg negativization is the last phase of
HBV chronic infection and represents its resolution. The aim of this
study was to analyze the frequency of HBsAg negativization in HBV
inactive carriers (HBV-IC) and to develop a predictive model of it.
Methods: 297 HBV-IC were studied, 51% males, 86% Caucasians,
42% genotype A and 35% genotype D, 67% with liver elastography
<6.2 kPa and with a mean age of 45±13 years. HBV-IC diagnosis was
based on HBeAg negativity and HBV-DNA <20000 IU/ml, confirmed
in several controls. HCV, HDV and HIV coinfection were excluded
in all. Basal determinations of HBV-DNA (RT-PCR, Cobas TaqMan
VHB) and quantitative HBsAg (Architect HBsAg; Abbott), with
lower limit of detection of 0.05 IU/ml, were performed. Patients
were prospectively followed annually or biannually, with a mean
follow-up of 52±28 months.
Results: 57/297 (19%) were initially HBV-DNA negative. Mean
HBsAg level was 8.852±17.700 IU/ml. During the follow-up, 49
patients (16.5%) became HBsAg-negative. In univariate analysis
(Kaplan–Meier), HBsAg negativization was not associated with sex
(p = 0.18), ALT normal or high values (p = 0.8), liver elastography
< or ≥6.2 kPa (p = 0.45), or race (p = 0.96). The probability of
HBsAg negativization was significantly higher in patients >30 years
(p = 0.02), HBV-DNA-negative (p < 0.001) and with initial HBsAg
<1000 UI (p < 0.001). In multivariate analysis, initial HBV-DNA
absence (HR 2.37 [95% CI 1.34–4.19], p = 0.03) and basal HBsAg
<1000 IU/ml (HR 49.4 [95% CI 6.76–361.02], p < 0.001) were
independently associated with the probability of HBsAg clearance.
The presence or absence of these factors allowed to establish three
groups of patients with a significant different probability of HBsAg
negativization at 5 years: In those without any favorable factor
(n = 151) such probability was 0%, in those with one factor (n = 101)
27.2%, and in patients with both of them (n = 45) 53.5% (p < 0.001).
Isolated use of HBsAg was also useful to distinguish three groups
of patients with different probability of HBsAg negativization at
5 years: 0% in those with HBsAg >1000 UI/ml, 15.2% if HBsAg was
between 100 and 1000 IU/ml and 53% when it was <100 IU/ml.
However, area under the ROC curve was greater in the model using
HBsAg and HBV-DNA (0.88 [0.83–0.92]) than in the one based only
in HBsAg (0.84 [0.78–0.89]).
Conclusions: In a series of HBV-IC, mainly Caucasians, the
combination of HBsAg cuantification and the presence or absence of
HBV-DNA is useful to predict the probability of infection resolution
at 5 years.

StephenW

P0593
乙肝表面抗原NEGATIVIZATION在非活动预测模型
乙肝表面抗原慢性携带者，主要是白种人
M.L. Gonza'雷斯Die'guez1，C.A. Navascue' S1，G Albines1，
奔驰Rodr'ıguez2，五Cadah'ıa1，M Varela1，R. P'erez1，
曼努埃尔Rodr'ıguez1。 1Liver单位，2Microbiology署，医院
宇宙报中央阿斯图里亚斯，西班牙奥维耶多
电子信箱：[email protected]
背景和目的：乙肝表面抗原negativization是最后阶段
乙肝病毒慢性感染，并代表其分辨率。这样做的目的
研究是分析的HBsAg negativization在HBV频率
非活动性携带者（HBV-IC），并制定了它的预测模型。
方法：297 HBV-IC进行了研究，51％的男性，86％的白种人，
42％的基因型A和35％D基因型，67％肝脏弹性
<6.2千帕和45±13岁，平均年龄。 HBV-IC的诊断是
基于对HBeAg阴性和HBV-DNA <20000 IU / ml时，证实
在几个控件。 HCV，HDV和HIV合并感染被排除
在所有。 HBV-DNA的基底测定（RT-PCR，科瓦斯的TaqMan
VHB）和定量的HBsAg（乙肝表面抗原建筑师;雅培），与
检测为0.05单位/毫升的低限值，进行。病人
每年或每两年进行前瞻性随访，平均
随访52±28个月。
结果：57/297（19％）为最初的HBV-DNA阴性。意味着
乙肝表面抗原水平为8.852±17.700 IU / ml的。在随访中，49
例（16.5％）成为HBsAg阴性。在单因素分析
（Kaplan-Meier法），乙肝表面抗原negativization与性别有关
（p值= 0.18），ALT正常或高值（p值= 0.8），肝弹性
<或≥6.2千帕（P = 0.45），或种族（P = 0.96）。的概率
乙肝表面抗原negativization是显著高于患者>30年
（p值= 0.02），HBV-DNA阴性（P <0.001），并与初始的HBsAg
<1000的UI（P <0.001）。在多变量分析，初步HBV-DNA
没有（HR 2.37 [95％CI 1.34-4.19]，P = 0.03）和基础的HBsAg
<1000 IU /毫升（HR 49.4 [95％CI为6.76-361.02]，P <0.001）
与HBsAg清除的概率独立相关。
存在或不存在这些因素允许建立三个
患者的HBsAg的显著不同群体的概率
negativization 5年：在那些没有任何有利因素
（N = 151），这样的概率为0％，在那些与一种因子（N = 101）
27.2％，而在患者与他们两个（N = 45），53.5％（P <0.001）。
孤立使用的HBsAg也有助于区分三个组
患者在不同的HBsAg概率的negativization
5年内：在那些与乙肝表面抗原> 1000 UI /毫升，15.2乙肝表面抗原是否是％0％
介于100和1000国际单位/毫升和53％时，它是<100国际单位/毫升。
然而，使用ROC曲线下面积是更大的模型
HBsAg和HBV-DNA（0.88 [0.83-0.92]），比在一个仅根据
在乙肝表面抗原（0.84 [0.78-0.89]）。
结论：在一系列的HBV-IC，主要白种人，的
的HBsAg cuantification的组合并的存在或不存在
HBV-DNA是有用的预测分辨率感染的概率
在5年。

咬牙硬挺

感谢分享

682256

对白种人研究，经过5年，
表面抗原定量>1000iu/ml，表面抗原转阴率为0；表面抗原定量在100-1000iu/ml之间，表面抗原转阴率为15.2%；
表面抗原定量<100iu/ml，表面抗原转阴率为53%。

682256

联合表面抗原定量和HBV-DNA两个因素，对此预测，比单独参考表面抗原，更加准确？

682256

联合表面抗原定量和HBV-DNA两个因素，对此预测，比单独参考表面抗原，更加准确？

682256

西班牙的研究，主要是A,D型病毒株型。本文影响因子，也不知多少分？对亚洲人种，B,C型株型多，此研究结论是否适用？

682256

表面抗原定量高和DNA定量高，对病情不利。这是明确无误的？