动态测量的HBsAg HBV预测活动

StephenW

Dynamic HBsAg measurements predict HBV inactivity
Published on April 13, 2016 at 5:15 PM ·
By Shreeya Nanda

In patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B virus (HBV) infection, repeated measurement of hepatitis B surface antigen (HBsAg) during long-term follow-up can help identify those with inactive virus, suggests a chart review.

"HBsAg levels seem to better reflect the natural history [of infection] and a revision of the definitions including HBsAg levels may ease the management of HBeAg negative [chronic HBV]", say Willem Brouwer, from Erasmus MC in Rotterdam, the Netherlands, and team.

Among 292 treatment-naïve noncirrhotic chronic HBV patients with baseline HBV DNA levels below 20,000 IU/mL, 189 were deemed inactive carriers - HBV DNA of 2000 IU/mL or less and persistently normal serum alanine aminotransferase concentrations as per the current criteria - after a year of follow-up, while the remaining 103 had HBV activity.


When participants were stratified by baseline HBsAg levels, those with low HBsAg levels (ie <100 IU/mL) had significantly lower 5- and 10-year cumulative probabilities of HBV activity than patients with intermediate (100-1000 IU/mL) or high (>1000 IU/mL) levels of HBsAg (p=0.009).

And patients with low HBsAg levels were significantly more likely to remain in the inactive carrier phase in the following year (p<0.001), with a probability of 97% compared with 85% for patients with intermediate levels and 74% for those with high levels.

The researchers assessed the diagnostic performance of various combinations of HBsAg and HBV DNA levels, and found that a cutoff of HBsAg levels no higher than 100 IU/mL and HBV DNA levels no higher than 2000 IU/mL predicted inactive carrier status in the next year with a specificity of 98% and a positive predictive value of 97%.

Moreover, a combination of HBV DNA levels of 5000 IU/mL or less and a decline in HBsAg levels of at least 0.5 log IU/mL identified patients likely to become inactive carriers in the following year with a specificity of 99%, a sensitivity of 16%, a positive predictive value of 83% and a negative predictive value of 72%.

These patients have a high probability of becoming inactive carriers and "may therefore not require antiviral therapy", say Brouwer et al.

Based on their findings, the study authors propose that inactive carriers be defined "as those with both an HBV DNA ≤2000 IU/mL and HBsAg <100 IU/mL".

And those who fulfil the current criteria for inactive status but have HBsAg levels between 100 and 1000 IU/mL "should be defined as 'HBV remission patients' and should be kept under close surveillance for at least 1 more year to confirm [inactive carrier] status", they write in Clinical Gastroenterology and Hepatology.

Licensed from medwireNews with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.



Posted in: Medical Research News

Tags: Alanine, Antigen, DNA, Gastroenterology, HBV, Hepatitis B, Hepatitis B Virus, Hepatology, Infectious disease, Virus

StephenW

动态测量的HBsAg HBV预测活动
在下午5:15公布的2016年4月13日·
通过Shreeya南达

在乙肝患者e抗原（HBeAg）阴性慢性乙型肝炎病毒（HBV）感染，在长期随访乙肝表面抗原（HBsAg）的重复测量可以帮助识别那些不活跃的病毒，建议一个图审查。

“HBsAg水平似乎更能体现自然史[感染]和定义，包括HBsAg水平可以缓解HBeAg阴性[慢性HBV]管理的修订版”，说威廉布劳威尔，从伊拉兹马斯MC在鹿特丹，荷兰和球队。

间292初治非肝硬化慢性HBV患者20,000以下国际单位/毫升基线HBV DNA水平，189被视为不活动的载体 - 2000国际单位/毫升或更小的HBV DNA和持续正常血清丙氨酸转氨酶浓度按现行标准 - 后随访一年，而其余103有乙肝病毒活性。


当参与者被基线HBsAg水平，那些低HBsAg水平（即<100 IU / mL）的分层有患者比显著低于5年和10年的HBV活性的累计概率和中间体（100-1000国际单位/毫升）或高（> 1000国际单位/毫升）的HBsAg的水平（p值= 0.009）。

与低的患者HBsAg水平用85％的患者具有中间水平和74％对那些具有高度水平相比有显著更可能保持在非活动载波相位在下面年（P <0.001），97％的概率。

研究人员评估HBsAg和HBV DNA水平的各种组合的诊断性能，发现HBsAg水平不超过100 IU / mL和HBV DNA水平不高于2000 IU / mL的预测，在明年惰性载体地位较高的截止为98％的特异性和97％的阳性预测值。

此外，5000国际单位/毫升或更小的HBV DNA水平的组合，在至少为0.5的HBsAg水平下降登录国际单位/毫升鉴定可能成为不活动的载体在以下一年的99％的特异性，的灵敏度的患者16％，83％，阳性预测值和72％，阴性预测值。

这些患者有机会成为非活动性携带者高概率“，因此可能不需要抗病毒治疗”，说布劳威尔等。

根据他们的研究结果，该研究的作者提出，非活动性携带者被定义为“那些既是HBV DNA≤2000IU / mL和HBsAg的<100 IU / mL的”。

而那些谁符合现行标准为不活跃状态，但有100个和1000个国际单位/毫升“之间的HBsAg水平应被定义为”乙肝缓解患者，应密切监视被至少保存1多一年，以确认[惰性载体]地位“，他们写在临床胃肠病学和肝病。

从与施普林格保健品有限公司©斯普林格保健品有限公司保留所有权利许可medwireNews许可。无论这些政党的认可或推荐任何商业产品，服务或设备。



发表在：医学研究新闻

标签：丙氨酸，抗原，DNA，消化内科，乙肝病毒，乙肝病毒，乙肝病毒，肝病，传染病，病毒

csfluke

意思是表抗降到100IU以下就可以考虑停止抗病毒了？不过表抗都降到这么低了，是我估计会坚持到转阴吧

StephenW

csfluke 发表于 2016-4-15 11:40
意思是表抗降到100IU以下就可以考虑停止抗病毒了？不过表抗都降到这么低了，是我估计会坚持到转阴吧 ...

不清楚,需要阅读整篇文章.
只能说, hbvdna < 2,000 iu/ml, 表抗100IU以下 - 非活动性携带, 不需要治疗.

smilingcloud

类似的研究2011年有过，日本的治疗指南中写进去了。

根据HBcr-Ag和HBs-Ag来预计，停止抗病毒治疗后复发的风险。  




没看原文，不知道这次的研究比较以前有什么进展。