在治疗过的亚洲阳性患者HBeAg和前C区共存和/或基础核心启动

StephenW

J Clin Gastroenterol. 2016 Aug 22. [Epub ahead of print]
Clinical Features of Chronic Hepatitis B in Treatment-naive Asian Patients With Positive HBeAg and Coexisting Precore and/or Basal Core Promoter Mutations.Pan CQ1, Dai E, Bhamidimarri KR, Zeng Z, Yin P.
Author information

• 1*Department of Medicine, Division of Gastroenterology, New York University Langone Medical Center, New York University School of Medicine, New York, NY †Division of Liver Diseases, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang §Department of Infectious Diseases, Peking University First Hospital, Beijing, China ‡Miami Transplant Institute, University of Miami, Miami, FL ∥St George's University School of Medicine, Grenada, West Indies.
  

AbstractBACKGROUND: Precore or/and basal core promoter (PC/BCP) mutations are frequently detected in hepatitis B e antigen (HBeAg)-negative patients, but little is known about their clinical significance in HBeAg-positive patients.
AIM: To characterize and report the clinical features of treatment-naive chronic hepatitis B patients who are HBeAg positive and harbor PC and/or BCP mutations.
PATIENTS AND METHODS: Consecutive treatment-naive patients with chronic hepatitis B between 2004 and 2014 were enrolled. Clinical characteristics were compared based on the stratification of HBeAg status and the presence of PC/BCP mutations. In addition, subset analysis in HBeAg-positive cohort was performed to compare clinical features of patients with and without PC/BCP mutations RESULTS:: Of the 267 patients enrolled from 3 centers, 177 were HBeAg positive and 90 HBeAg negative. When compared with HBeAg-negative patients, HBeAg-positive patients were significantly younger in mean age (37.93 vs. 44.40; P<0.001), had higher levels of median ALT (51 vs. 30.5 U/mL; P<0.001), higher levels of mean HBV DNA (7.50±1.48 vs. 5.10±1.44 log10 copies/mL; P<0.001), and lower frequency of detectable PC/BCP mutations (60.45% vs. 93.33%; P<0.001), but had significantly higher frequency of BCP when mutations were detected (37.85% vs. 22.22%; P=0.013). Among HBeAg-positive patients, when compared with patients with wild type, those with PC/BCP mutations were significantly older (30.63 vs. 42.71; P<0.001), had higher median ALT levels (29.5 vs. 73 U/mL; P<0.001), but there was no significant association with mean HBV DNA levels (7.96 vs. 7.20 log10 copies/mL; P=0.865) or HBV genotype (P=1.000). In the multivariate analysis, only age and ALT were independently associated with PC/BCP mutations in HBeAg-positive patients, but there was no association with HBV genotype or DNA.
CONCLUSIONS: PC/BCP mutants were frequent (up to 60%) in treatment-naive HBeAg-positive patients and were associated with distinct clinical characteristics when compared with patients with wild type or HBeAg negative. Future large studies are needed to substantiate the long-term clinical outcomes when PC/BCP mutations are detected in HBeAg-positive patients as it may impact the natural history or treatment response in such patients.


PMID:27552328DOI:10.1097/MCG.0000000000000664

StephenW

Ĵ临床Gastroenterol。 2016年八月22提前打印EPUB]
在治疗过的亚洲阳性患者HBeAg和前C区共存和/或基础核心启动子突变慢性乙型肝炎的临床特征。
潘CQ1，戴E，Bhamidimarri KR，曾Z，尹P.
作者信息

    1 *内科，消化，纽约大学Langone医学中心，医学，纽约的纽约大学法学院，肝病纽约†分工司系，河北医科大学石家庄市第五医院，传染病石家庄§Department ，北京大学第一医院，北京，中国‡迈阿密移植研究所，迈阿密大学，迈阿密，医药，格林纳达，西印度群岛FL∥St圣乔治大学学院。

抽象
背景：

前C区和/或基础核心启动子（PC / BCP）突变是乙肝e抗原（HBeAg）阴性的患者经常检测到，但鲜为人知的是，在HBeAg阳性患者的临床意义。
目标：

为了描述和报告未治疗的慢性乙肝患者谁是HBeAg阳性和海港PC和/或BCP突变的临床特征。
患者和方法：

连续治疗初治患者与2004年和2014年之间的慢性乙型肝炎患者。临床特征的基础上的HBeAg状态的分层和PC / BCP突变的存在进行了比较。此外，进行HBeAg阳性队列子集分析患者的临床特征比较和无PC / BCP突变结果显示：在267例患者中3中心就读，177人HBeAg阳性和90 HBeAg阴性。当HBeAg阴性患者相比，HBeAg阳性患者的平均年龄年轻显著（37.93与44.40，P <0.001），有较高水平的中位数ALT（51与30.5 U /毫升; P <0.001）高，平均HBV DNA水平（7.50±1.48 5.10与1.44±log10拷贝/毫升; P <0.001），检出PC / BCP突变频率较低（60.45％比93.33％; P <0.001），但有显著较高当检测到的BCP频率突变（37.85％对22.22％; P = 0.013）。在HBeAg阳性患者，当患者与野生型相比，那些与PC / BCP突变显著较大（30.63主场迎战42.71; P <0.001），有较高的平均ALT水平（29.5对比73 U / mL的; P < 0.001），但与平均HBV DNA水平（7.96与7.20 log10拷贝/毫升无显著的关联; P = 0.865）或HBV基因型（P = 1.000）。在多变量分析，只有年龄和ALT与HBeAg阳性患者PC / BCP突变独立相关，但与HBV基因型或DNA无关。
结论：

PC / BCP变异频繁（高达60％）在治疗过的HBeAg阳性患者时与患者用野生型或HBeAg阴性相比具有明显的临床特征进行关联。还需要更多的大型研究证实长期临床结果时HBeAg阳性患者中检测到PC / BCP突变，因为它可能会影响这类病人的自然史和治疗反应。

结论：
    27552328
DOI：
    10.1097 / MCG.0000000000000664