HBsAg和HBcrAg是HBeAg阳性患者用核苷类似物治疗HBeAg血清学转换

StephenW

J Viral Hepat. 2018 Mar 13. doi: 10.1111/jvh.12889. [Epub ahead of print]
HBsAg and HBcrAg as predictors of HBeAg seroconversion in HBeAg-positive patients treated with nucleos(t)ide analogues.Wang B1, Carey I1, Bruce M1, Montague S1, Dusheiko G1,2, Agarwal K1.
Author information
1Institute of Liver Studies, King's College Hospital, London, UK.2University College London Medical School, London, UK.

AbstractHBeAg seroconversion marks an important spontaneous change and treatment end-point for HBeAg-positive patients and is a pre-requisite for HBsAg loss or functional cure. In this retrospective analysis, we aimed to identify predictors of seroconversion using serum quantitative HBsAg and HBcrAg, in HBeAg-positive patients treated with nucleos(t)ide analogues (NA). Data and samples from 118 HBeAg-positive adults (genotypes A-G) started on NA between Jan 2005-Sept 2016 were retrospectively analysed at several time-points. The predictive power of on-treatment levels of HBsAg and HBcrAg were determined using receiver operating curve (ROC) analysis and cut-off values determined by maximized Youden's index. 36.4% of patients achieved HBeAg seroconversion after a median of 39 months' treatment. On treatment kinetics of HBV DNA, HBsAg and HBcrAg differed between HBeAg seroconverters and non-seroconverters. A combination of HBsAg and HBcrAg had the greatest predictive value for HBeAg seroconversion: at 6 months, HBsAg of 3.9 log10 IU/mL and HBcrAg of 5.7 log10 U/mL had a sensitivity of 71.4%, specificity of 79.5%, positive predictive value (PPV) of 65.2% and negative predictive value (NPV) of 83.8%, with AUROC of 0.769 (0.668, 0.869; 95%CI), and at 12 months, HBsAg 3.8 log10 IU/mL and HBcrAg 5.5 log10 U/mL had a sensitivity of 73.7%, specificity of 79.5%, PPV of 63.6% and NPV of 86.1%, with AUROC 0.807 (0.713, 0.901; 95% CI). In conclusion, our results may be used to identify patients who are unlikely to achieve treatment end-points, which will be important as the future management of chronic hepatitis B looks to therapies that offer functional cure. This article is protected by copyright. All rights reserved.


KEYWORDS: Hepatitis B; hepatitis B core-related antigen; hepatitis B e antigen seroconversion; hepatitis B surface antigen; nucleos(t)ide analogue

PMID:29532589DOI:10.1111/jvh.12889

StephenW

J Viral Hepat。 2018年3月13日：doi：10.1111 / jvh.12889。 [电子版提前打印]
HBsAg和HBcrAg是HBeAg阳性患者用核苷类似物治疗HBeAg血清学转换的预测指标。
Wang B1，Carey I1，Bruce M1，Montague S1，Dusheiko G1,2，Agarwal K1。
作者信息

1
    英国伦敦国王学院医院肝脏研究所。
2
    伦敦大学学院医学院，伦敦，英国。

抽象

HBeAg血清学转换标志着HBeAg阳性患者的重要自发改变和治疗终点，并且是HBsAg消失或功能治愈的先决条件。在这项回顾性分析中，我们旨在用核苷（酸）类似物（NA）治疗HBeAg阳性患者，利用血清定量HBsAg和HBcrAg鉴定血清转化的预测因子。在数个时间点回顾性分析了2005年1月至2016年9月间从NA开始的118例HBeAg阳性成人（基因型A-G）的数据和样本。使用受试者操作曲线（ROC）分析和通过最大化的Youden指数确定的截断值确定HBsAg和HBcrAg的治疗水平的预测能力。在平均39个月的治疗后，36.4％的患者达到了HBeAg血清学转换。关于HBV DNA治疗动力学，HBeAg血清转变者和非血清转变者之间HBsAg和HBcrAg不同。 HBsAg和HBcrAg的组合对HBeAg血清学转换具有最大的预测价值：在6个月时，HBsAg为3.9 log10 IU / mL和HBcrAg为5.7 log10 U / mL的敏感性为71.4％，特异性为79.5％，阳性预测值PPV）为65.2％，阴性预测值（NPV）为83.8％，AUROC为0.769（0.668,0.869,95％CI），12个月时HBsAg 3.8 log10 IU / mL和HBcrAg 5.5 log10 U / mL敏感度73.7％，特异性79.5％，PPV 63.6％，NPV 86.1％，AUROC 0.807（0.713,0.901; 95％CI）。总之，我们的研究结果可能用于识别不太可能达到治疗终点的患者，这对未来慢性乙型肝炎的治疗看起来可以提供功能性治疗的疗法很重要。本文受版权保护。版权所有。
关键词：

乙型肝炎;乙型肝炎核心相关抗原;乙型肝炎e抗原血清学转换;乙型肝炎表面抗原;核苷（t）ide类似物

结论：
    29532589
DOI：
    10.1111 / jvh.12889