产妇的HBsAg可以作为乙肝病毒垂直传播标记

StephenW

Maternal HBsAg can serve as HBV vertical transmission marker
Published on June 23, 2016 at 1:15 AM · No Comments


By Shreeya Nanda

Two studies have independently identified quantitative hepatitis B surface antigen (HBsAg) as a marker to identify pregnant women with chronic hepatitis B virus (HBV) infection whose infants are at high-risk of infection despite immunoprophylaxis.

The authors of both studies believe that use of quantitative HBsAg could be a valid alternative to HBV DNA testing to identify high-risk mothers and determine eligibility for treatment, especially in resource-limited regions as the currently available assays to quantify HBV DNA levels are expensive.

The first of these studies, conducted in a Taiwanese cohort of 568 HBsAg-positive women who did not receive antiviral therapy during pregnancy, found a strong positive correlation between quantitative maternal HBsAg titres and maternal viral load (r=0.69; p<0.001). However, the correlation was mainly driven by the subgroup of women positive for hepatitis B e antigen (HBeAg), in whom HBsAg and HBV DNA levels correlated strongly (r=0.65; p<0.001), while the correlation in HBeAg-negative participants was suboptimal (r=0.12; p=0.046), the team reports.

Multivariate analysis showed that infants of mothers with higher HBsAg levels had a significantly increased risk of infection, with an adjusted odds ratio (OR) for each log10 IU/mL rise of 15.02 (p<0.001). Higher maternal HBV DNA levels were the only other factor associated with an increased vertical transmission risk (adjusted OR for each log10 IU/mL increase=2.36; p<0.001).

Area under the receiver operating characteristic curve (AUC) analysis showed that quantitative HBsAg predicted infection in infants with 89% accuracy, which was comparable to the 87% accuracy of maternal viral load to predict infection.


And at the optimal cutoff of 4.10 log10 IU/mL, maternal quantitative HBsAg predicted infant infection with a sensitivity of 100.0% and a specificity of 71.3%, Huey-Ling Chen (National Taiwan University Hospital, Taipei) and colleagues report in Hepatology.

In the other study, a Canadian team recruited a multi-ethnic (65% Asian, 23% African, 12% Caucasian or Hispanic) cohort of 99 pregnant women with chronic HBV, of whom 13% received tenofovir disoproxil fumarate for a median of 83 days prior to delivery.

In this study, the optimal quantitative HBsAg cutoff was 4.3 log10 IU/mL to predict HBV DNA levels of 7.0 log10 IU/mL and above, known to be associated with immunoprophylaxis failure, say the researchers. At this cutoff, quantitative HBsAg was 98.7% accurate, 94.7% sensitive and 94.4% specific for high maternal viraemia.

In contrast to the Taiwanese study, Carla Coffin, from the University of Calgary in Alberta, and fellow investigators only found a moderate correlation between quantitative HBsAg and HBV DNA levels, although the correlation was significant (r=0.44; p<0.05). But similar to Chen et al, HBsAg and maternal viraemia correlated strongly and significantly in HBeAg-positive women (r=0.79; p<0.05), but not in those negative for HBeAg (r=0.17; p=0.06).

Coffin et al write in Liver International: "Given the very low risk of transmission in HBeAg-negative pregnant patients, [quantitative HBsAg] testing for predicting high maternal viraemia could be performed only in HBeAg-positive mothers, especially in resource poor regions."
Source:

Hepatology 2016; Liver Int 2016

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StephenW

产妇的HBsAg可以作为乙肝病毒垂直传播标记
在上午1:15·没有评论发表于2016年6月23日，


通过Shreeya南达

两项研究独立确定定量乙肝表面抗原（HBsAg）作为标记，以确定孕妇患有慢性乙型肝炎病毒（HBV）感染的婴儿感染的高风险，尽管免疫预防。

这两项研究的作者认为，采用量化的HBsAg可能是HBV DNA检测的有效替代，以确定高风险的母亲和确定治疗资格，尤其是作为现有检测资源有限的地区的量化HBV DNA水平都贵。

其中第一个研究中，在568谁在怀孕期间未接受抗病毒治疗的HBsAg阳性妇女的台湾队列进行，发现定量产妇乙肝表面抗原滴度和产妇的病毒载量之间有很强的正相关（r = 0.69，P <0.001）。但是，相关性主要是由妇女阳性为乙型肝炎e抗原（HBeAg），在其中的HBsAg和HBV DNA水平强相关的子组从动性（r = 0.65; P <0.001），而在HBeAg阴性参与者的相关性次优相关（r = 0.12，p = 0.046），小组的报告。

多因素分析表明，较高的HBsAg水平母亲的婴儿有显著增加感染的风险，为15.02（P <0.001）的每个日志10 IU / mL的上升调整后的比值比（OR）。较高的产妇HBV DNA水平与增加垂直传播的危险（OR调整为每个日志10 IU / mL的增加= 2.36，P <0.001）相关联的唯一因素。

受试者工作特征曲线（AUC）分析下面积表明，定量的HBsAg与89％的准确度，这是比得上母体病毒负荷预测感染的87％的精度婴儿预测感染。


而在4.10日志10 IU / mL的最优截止，母亲乙肝表面抗原定量预测与100.0％的敏感性和71.3％的特异性，陈慧玲（台大医院，台北）和同事在报告肝病婴儿感染。

在另一项研究中，加拿大队找来一个多民族（65％为亚裔，23％的非裔，12％的白人或西班牙裔）99孕妇有慢性HBV，其中13％接受富马酸替诺福韦酯为83位数的队列之前交付天。

在这项研究中，最佳的量化的HBsAg截止为4.3 log10的国际单位/毫升到预测7.0 log10的国际单位/毫升的HBV DNA水平以上，已知与免疫预防故障相关，研究人员说。在这个截止，乙肝表面抗原定量是98.7％准确，94.7％敏感，94.4％的特定高产妇病毒血症。

相较于台湾的研究，卡拉棺材，卡尔加里阿尔伯塔大学，和同事调查只发现定量HBsAg和HBV DNA水平呈中度相关，但相关性是显著相关（r = 0.44，P <0.05）。但类似陈等人，乙肝表面抗原和病毒血症产妇HBeAg阳性的妇女强烈和显著相关（r = 0.79，P <0.05），但不是在那些消极的HBeAg的相关（r = 0.17，P = 0.06）。

Coffin等写在肝国际：“鉴于传输HBeAg阴性孕妇患者的风险非常低，预测高产妇的病毒血症[定量的HBsAg]测试可仅在HBeAg阳性的母亲进行的，尤其是在资源贫乏的地区。”
资源：

肝病2016年;肝诠释2016年

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