电子健康信息学数据描述慢性乙型肝炎病毒感染中乙型肝炎

StephenW

MBio. 2019 Jun 25;10(3). pii: e00699-19. doi: 10.1128/mBio.00699-19.
Electronic Health Informatics Data To Describe Clearance Dynamics of Hepatitis B Surface Antigen (HBsAg) and e Antigen (HBeAg) in Chronic Hepatitis B Virus Infection.
Downs LO#1,2, Smith DA#2,3, Lumley SF1,2, Patel M1, McNaughton AL2, Mokaya J2, Ansari MA2, Salih H4, Várnai KA3, Freeman O4, Cripps S5, Phillips J6, Collier J6, Woods K3, Channon K3, Davies J4, Barnes E2,3,6, Jeffery K1, Matthews PC7,2,3.
Author information

1
    Department of Infectious Diseases and Microbiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
2
    Nuffield Department of Medicine, Medawar Building for Pathogen Research, University of Oxford, Oxford, United Kingdom.
3
    NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, National Institute for Health Research Health Informatics Collaborative, Oxford, United Kingdom.
4
    Oxford NIHR Biomedical Research Centre Clinical Informatics Group, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom.
5
    Pharmacy Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
6
    Department of Hepatology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
7
    Department of Infectious Diseases and Microbiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom [email protected].
#
    Contributed equally

Abstract

HBsAg and HBeAg have gained traction as biomarkers of control and clearance during chronic hepatitis B virus infection (CHB). Improved understanding of the clearance correlates of these proteins could help inform improvements in patient-stratified care and advance insights into the underlying mechanisms of disease control, thus underpinning new cure strategies. We collected electronic clinical data via an electronic pipeline supported by the National Institute for Health Research Health Informatics Collaborative (NIHR HIC), adopting an unbiased approach to the generation of a robust longitudinal data set for adults testing HBsAg positive from a large UK teaching hospital over a 6-year period (2011 to 2016 inclusive). Of 553 individuals with CHB, longitudinal data were available for 319, representing >107,000 weeks of clinical follow-up. Among these 319 individuals, 13 (4%) cleared HBsAg completely. Among these 13, the HBsAg clearance rate in individuals on nucleos(t)ide analogue (NA) therapy (n = 4 [31%]; median clearance time,150 weeks) was similar to that in individuals not on NA therapy (n = 9 [69%]; median clearance time, 157 weeks). Those who cleared HBsAg were significantly older and less likely to be on NA therapy than nonclearers (P = 0.003 and P = 0.001, respectively). Chinese ethnicity was associated with HBeAg positivity (P = 0.025). HBeAg clearance occurred in individuals both on NA therapy (n = 24; median time, 49 weeks) and off NA therapy (n = 19; median time, 52 weeks). Improved insights into the dynamics of these biomarkers can underpin better prognostication and patient-stratified care. Our systematized approach to data collection paves the way for scaling up efforts to harness clinical data to address research questions and support improvements in clinical care.IMPORTANCE Advances in the diagnosis, monitoring, and treatment of hepatitis B virus (HBV) infection are urgently required if we are to meet international targets for elimination by the year 2030. Here we demonstrate how routine clinical data can be harnessed through an unbiased electronic pipeline, showcasing the significant potential for amassing large clinical data sets that can help to inform advances in patient care and provide insights that may help to inform new cure strategies. Our cohort from a large UK hospital includes adults from diverse ethnic groups that have previously been underrepresented in the literature. By tracking two protein biomarkers that are used to monitor chronic HBV infection, we provide new insights into the timelines of HBV clearance, both on and off treatment. These results contribute to improvements in individualized clinical care and may provide important clues into the immune events that underpin disease control.

Copyright © 2019 Downs et al.
KEYWORDS:

biomarker; health informatics; hepatitis B virus; surface antigen; viral clearance

PMID:
    31239374
DOI:
    10.1128/mBio.00699-19

StephenW

姆比奥。 2019年6月25日; 10（3）。 pii：e00699-19。 doi：10.1128 / mBio.00699-19。
电子健康信息学数据描述慢性乙型肝炎病毒感染中乙型肝炎表面抗原（HBsAg）和e抗原（HBeAg）的清除动态。
Downs LO＃1,2，Smith DA＃2,3，Lumley SF1,2，Patel M1，McNaughton AL2，Mokaya J2，Ansari MA2，Salih H4，VárnaiKA3，Freeman O4，Cripps S5，Phillips J6，Collier J6，Woods K3，Channon K3，Davies J4，Barnes E2,3,6，Jeffery K1，Matthews PC7,2,3。
作者信息

1
牛津大学医院NHS基金会信托基金会John Radcliffe医院传染病与微生物学系，英国牛津。
2
英国牛津大学牛津大学医学院病原体研究中心Nuffield医学系。
3
NIHR牛津生物医学研究中心，John Radcliffe医院，牛津大学医院NHS基金会信托，国立健康研究所健康信息学协作，英国牛津。
4
牛津NIHR生物医学研究中心临床信息学组，大数据研究所，李嘉诚健康信息与发现中心，牛津大学，牛津，英国。
五
药房部，John Radcliffe医院，牛津大学医院NHS基金会信托，英国牛津。
6
英国牛津大学医院NHS基金会信托基金会John Radcliffe医院肝病科。
7
英国牛津大学医院NHS基金会信托基金会John Radcliffe医院传染病与微生物学系[email protected]。
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贡献一致

抽象

在慢性乙型肝炎病毒感染（CHB）期间，HBsAg和HBeAg作为控制和清除的生物标志物已经获得了关注。更好地了解这些蛋白质的清除相关性有助于改善患者分层护理并提高对疾病控制潜在机制的洞察力我们通过国家健康研究所健康信息学协作组织（NIHR）支持的电子管道收集电子临床数据HIC），采用无偏见的方法为成人检测HBsAg阳性生成强大的纵向数据集来自英国一家大型教学医院，为期6年（2011年至2016年）。在553名患有CHB的个体中，纵向数据可用于319，代表> 107,000周的临床随访。在这319人中，13人（4％）完全清除了HBsAg。在这13例中，核苷（酸）类似物（NA）治疗（n = 4 [31％];中位清除时间，150周）的个体HBsAg清除率与未接受NA治疗的个体相似（n = 9 [69％];中位数清除时间，157周）。那些清除HBsAg的患者显着年龄较大且不太可能接受NA治疗而非非清洁者（分别为P = 0.003和P = 0.001）。中国人种族与HBeAg阳性有关（P = 0.025）。在NA治疗（n = 24;中位数时间，49周）和NA治疗（n = 19;中位时间，52周）的个体中均发生HBeAg清除。对这些生物标志物动态的深入了解可以支持更好的预后和患者分层护理。我们系统化的数据收集方法为扩大利用临床数据解决研究问题和支持临床护理改进的工作铺平了道路。重要性如果我们要在2030年之前达到国际Al目标的消除，则迫切需要在乙型肝炎病毒（HBV）感染的诊断，监测和治疗方面取得进展。这里我们展示了如何通过无偏见的电子技术利用常规临床数据管道，展示了积累大量临床数据集的巨大潜力，这些数据集有助于为患者护理的进展提供信息，并提供可能有助于提供新治疗策略信息的见解。我们来自英国一家大型医院的队列包括以前在文献中代表性不足的模式种族群体的成年人。通过跟踪用于监测慢性HBV感染的两种蛋白质生物标志物，我们提供了关于HBV清除时间表的新见解，包括治疗和治疗。这些结果有助于个体化临床护理的改善，并可能为支持疾病控制的免疫事件提供重要线索。

版权所有©2019 Downs et al。
关键词：

Biocodeer;健康信息学;乙型肝炎病毒;表面抗原;病毒清除

结论：
31239374
DOI：
10.1128 / mBio.00699-19

StephenW

https://mbio.asm.org/content/10/3/e00699-19