与慢性HBV感染成人HBsAg血清清除率相关的因素：系统评价和Met

StephenW

Factors Associated With Rates of HBsAg Seroclearance in Adults With Chronic HBV Infection: A Systematic Review and Meta-analysis
Yee Hui Yeo
, Hsiu J. Ho
, Hwai-I Yang
, Tai-Chung Tseng
, Tetsuya Hosaka
, Huy N. Trinh
, Min-Sun Kwak
, Young Min Park
, James Yan Yue Fung
, Maria Buti
, Manuel Rodríguez
, Sombat Treeprasertsuk
, Carmen Monica Preda
, Teerapat Ungtrakul
, Phunchai Charatcharoenwitthaya
, Xiangyong Li
, Jiayi Li
, Jian Zhang
, Michael Huan Le
, Bin Wei
, Biyao Zou
, An Le
, Donghak Jeong
, Nicholas Chien
, Leslie Kam
, Chiao-Chin Lee
, Mar Riveiro-Barciela
, Doina Istratescu
, Tassanee Sriprayoon
, Yutian Chong
, Tawesak Tanwandee
, Mariko Kobayashi
, Fumitaka Suzuki
, Man-Fung Yuen
, Hyo-Suk Lee
, Jia-Horng Kao
, Anna S. Lok
, Chun-Ying Wu'Correspondence information about the author Chun-Ying WuEmail the author Chun-Ying Wu
, Mindie H. Nguyen'Correspondence information about the author Mindie H. NguyenEmail the author Mindie H. Nguyen
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DOI: https://doi.org/10.1053/j.gastro.2018.10.027 |
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Background & Aims

Seroclearance of hepatitis B surface antigen (HBsAg) is a marker for clearance of chronic hepatitis B virus (HBV) infection, but reported annual incidence rates of HBsAg seroclearance vary. We performed a systematic review and meta-analysis to provide more precise estimates of HBsAg seroclearance rates among subgroups and populations.
Methods

We searched PubMed, Embase, and the Cochrane library for cohort studies that reported HBsAg seroclearance in adults with chronic HBV infection with more than 1 year of follow-up and at least 1 repeat test for HBsAg. Annual and 5-, 10-, and 15-year cumulative incidence rates were pooled using a random effects model.
Results

We analyzed 34 published studies (with 42,588 patients, 303,754 person-years of follow-up, and 3194 HBsAg seroclearance events), including additional and updated aggregated data from 19 studies. The pooled annual rate of HBsAg seroclearance was 1.02% (95% CI, 0.79–1.27). Cumulative incidence rates were 4.03% at 5 years (95% CI, 2.49–5.93), 8.16% at 10 years (95% CI, 5.24–11.72), and 17.99% at 15 years (95% CI, 6.18–23.24). There were no significant differences between the sexes. A higher proportion of patients who tested negative for HBeAg at baseline had seroclearance (1.33%; 95% CI, 0.76–2.05) than those who tested positive for HBeAg (0.40%; 95% CI, 0.25–0.59) (P < .01). Having HBsAg seroclearance was also associated with a lower baseline HBV DNA level (6.61 log10 IU/mL; 95% CI, 5.94–7.27) vs not having HBsAg seroclearance (7.71 log10 IU/mL; 95% CI, 7.41–8.02) (P < .01) and with a lower level of HBsAg at baseline (2.74 log10 IU/mL; 95% CI, 1.88–3.60) vs not having HBsAg seroclearance (3.90 log10 IU/mL, 95% CI, 3.73–4.06) (P < .01). HBsAg seroclearance was not associated with HBV genotype or treatment history. Heterogeneity was substantial across the studies (I2 = 97.49%).
Conclusion

In a systematic review and meta-analysis, we found a low rate of HBsAg seroclearance in untreated and treated patients (pooled annual rate, approximately 1%). Seroclearance occurred mainly in patients with less active disease. Patients with chronic HBV infection should therefore be counseled on the need for lifelong treatment, and curative therapies are needed.
Keywords:
Natural History, Prognosis, Disease Progression, CHB
Abbreviations used in this paper:
ALT (alanine aminotransferase), cccDNA (covalently closed circular DNA), CHB (chronic hepatitis B), CI (confidence interval), HBeAg (hepatitis B e antigen), HBsAg (hepatitis B surface antigen), HBV (hepatitis B virus), HCC (hepatocellular carcinoma), NOS (Newcastle–Ottawa quality assessment scale)

StephenW

与慢性HBV感染成人HBsAg血清清除率相关的因素：系统评价和Meta分析
Yee Hui Yeo
，Hsiu J. Ho
，Hwai-I Yang
，Tai-Chung Tseng
，Tetsuya Hosaka
，Huy N. Trinh
，Min-Sun Kwak
，杨敏公园
，James Yan Yue Fung
，Maria Buti
，ManuelRodríguez
，Sombat Treeprasertsuk
，卡门莫妮卡普雷达
，Teerapat Ungtrakul
，Phunchai Charatcharoenwitthaya
，向永利
，李佳怡
，张健
，Michael Huan Le
，宾威
，毕尧邹
，安乐
，Donghak Jeong
，Nicholas Chien
，Leslie Kam
，李钦钦
，Mar Riveiro-Barciela
，Doina Istratescu
，Tassanee Sriprayoon
，玉田冲
，Tawesak Tanwandee
，Mariko Kobayashi
，Fumitaka Suzuki
，冯凤媛
，Hyo-Suk Lee
，Jia-Horng Kao
，Anna S. Lok
吴春英关于作者吴春英的作者信息，作者吴春英
，Mindie H. Nguyen'关于作者的相关信息Mindie H. Nguyen给作者Mindie H. Nguyen发邮件
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DOI：https：//doi.org/10.1053/j.gastro.2018.10.027 |
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背景与目的

乙型肝炎表面抗原（HBsAg）的血清清除是清除慢性乙型肝炎病毒（HBV）感染的标志物，但报告HBsAg血清清除率的年发病率不同。我们进行了系统评价和荟萃分析，以提供亚组和人群中HBsAg血清清除率的更准确估计。
方法

我们搜索了PubMed，Embase和Cochrane图书馆进行的队列研究，这些研究报告了慢性HBV感染成人HBsAg血清清除率超过1年的随访和至少1次HBsAg重复检测。使用随机效应模型汇总年度和5年，10年和15年累积发病率。
结果

我们分析了34项已发表的研究（42,588例患者，303,754人年随访，以及3194例HBsAg血清清除事件），包括来自19项研究的额外和更新的汇总数据。汇总的HBsAg血清清除率为1.02％（95％CI，0.79-1.27）。 5年累积发病率为4.03％（95％CI，2.49-5.93），10年时为8.16％（95％CI，5.24-11.72），15年为17.99％（95％CI，6.18-23.24）。两性之间没有显着差异。基线时检测HBeAg阴性的患者比例较高（1.33％; 95％CI，0.76-2.05），HBeAg检测阳性（0.40％; 95％CI，0.25-0.59）（P <.01） ）。 HBsAg血清清除率也与较低的基线HBV DNA水平（6.61 log10 IU / mL; 95％CI，5.94-7.27）相关，而不具有HBsAg血清清除率（7.71 log10 IU / mL; 95％CI，7.41-8.02）（P <.01）并且基线时HBsAg水平较低（2.74 log10 IU / mL; 95％CI，1.88-3.60），而不具有HBsAg血清清除率（3.90 log10 IU / mL，95％CI，3.73-4.06）（P <.01）。 HBsAg血清清除率与HBV基因型或治疗史无关。研究中的异质性很大（I2 = 97.49％）。
结论

在系统评价和荟萃分析中，我们发现未治疗和治疗的患者HBsAg血清清除率低（汇总年率约为1％）。血清清除主要发生在疾病活动较少的患者中。因此，应建议患有慢性HBV感染的患者终身治疗，并需要治疗。
关键词：
自然史，预后，疾病进展，CHB
本文中使用的缩写：
ALT（丙氨酸氨基转移酶），cccDNA（共价闭合环状DNA），CHB（慢性乙型肝炎），CI（置信区间），HBeAg（乙型肝炎e抗原），HBsAg（乙型肝炎表面抗原），HBV（乙型肝炎病毒）， HCC（肝细胞癌），NOS（纽卡斯尔 - 渥太华质量评估量表）

StephenW

https://www.gastrojournal.org/ar ... 18)35158-8/fulltext