HBV表面抗原定量在HBV e抗原阴性慢性HBV感染中的临床应用

StephenW

Clinical utility of HBV surface antigen quantification in HBV e antigen-negative chronic HBV infection

    Yun-Fan Liaw

Nature Reviews Gastroenterology & Hepatologyvolume 16, pages631–641 (2019) | Download Citation
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Abstract

Chronic hepatitis B virus (HBV) infection is a serious problem owing to its worldwide distribution and potential adverse sequelae that include cirrhosis and/or hepatocellular carcinoma. Current antiviral therapies have much improved outcomes, but few patients achieve the ultimate goal of hepatitis B surface antigen (HBsAg) loss (functional cure). As hepatitis B e antigen (HBeAg)-negative chronic HBV infection is the final phase prior to HBsAg loss, the management of patients in this phase together with quantification of HBsAg has attracted increasing clinical and research interest. This Review integrates the findings from research in HBsAg kinetics and discusses how they might inform our understanding and management of HBeAg-negative chronic HBV infection. Studies have shown that HBsAg levels are highly predictive of the presence of inactive HBV infection and that serial changes in HBsAg levels might predict HBsAg loss within 1–3 years. Data also suggest that quantitative HBsAg monitoring is important during hepatitis flare and antiviral therapy, especially in the timing of the decision to stop therapy and to start off-therapy retreatment. These findings have shed new light on the natural course of HBV infection and might lead to optimization of the management of HBeAg-negative chronic HBV infection and contribute to the paradigm shift from indefinite to finite therapy for patients with HBV infection.
Key points

    Chronic hepatitis B virus (HBV) infection is a serious clinical problem involving ~292 million people worldwide, and has the potential risk of adverse sequelae including cirrhosis and hepatocellular carcinoma.

    A hepatitis B surface antigen (HBsAg) level <1,000 IU/ml is indicative of inactive infection and a level <200 IU/ml with decline of >0.5 log10 IU/ml per year predicts HBsAg loss within 1–3 years.

    A hepatitis B e antigen (HBeAg)-negative patient with active infection requires nucleoside or nucleotide analogue (NUC) or interferon-based therapy; interferon-based therapy increases HBsAg decline and rate of loss.

    Rapid HBsAg decline of >0.5 log10 IU/ml in 6 months can lead to HBsAg levels of <100 IU/ml or HBsAg loss during NUC therapy.

    Stopping NUC therapy in sustained responders and those who achieve HBsAg <100 IU/ml by the end of therapy might increase the 5-year HBsAg loss by up to >30%.

    HBsAg kinetics during clinical relapse can help the retreatment decision; retreatment is required in those with increasing HBsAg levels, whereas retreatment might be unnecessary in those with decreasing HBsAg levels.

StephenW

HBV表面抗原定量在HBV e抗原阴性慢性HBV感染中的临床应用

    廖云凡

自然评论胃肠病学和肝脏病学第16卷，第631–641页（2019）|下载引文
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抽象

慢性乙型肝炎病毒（HBV）感染是一个严重的问题，这是由于其在世界范围内分布以及包括肝硬化和/或肝细胞癌在内的潜在不良后遗症。当前的抗病毒疗法具有改善的结局，但很少有患者达到乙型肝炎表面抗原（HBsAg）丧失（功能性治愈）的最终目标。由于乙型肝炎e抗原（HBeAg）阴性的慢性HBV感染是HBsAg丧失之前的最后阶段，因此该阶段的患者管理以及HBsAg的定量化吸引了越来越多的临床和研究兴趣。本综述整合了HBsAg动力学研究的结果，并讨论了它们如何为我们对HBeAg阴性慢性HBV感染的理解和管理提供信息。研究表明，HBsAg水平可高度预测是否存在非活动性HBV感染，并且HBsAg水平的连续变化可能会预测1-3年内HBsAg丢失。数据还表明，在肝炎发作和抗病毒治疗期间，尤其是在决定停止治疗和开始非治疗再治疗的时机中，定量HBsAg监测非常重要。这些发现为HBV感染的自然过程提供了新的思路，并可能导致对HBeAg阴性慢性HBV感染的管理的优化，并有助于从HBV感染患者的无限期治疗过渡到有限治疗。
关键点

    慢性乙型肝炎病毒（HBV）感染是一个严重的临床问题，涉及全世界约2.92亿人，并且具有包括肝硬化和肝细胞癌在内的不良后遗症的潜在风险。

    乙型肝炎表面抗原（HBsAg）水平<1,000 / IU / ml表示无活动性感染，而水平<200 IU / ml并且每年下降> 0.5 log10 IU / ml则可预测1-3年内HBsAg损失。

    具有活动性感染的乙肝e抗原（HBeAg）阴性患者需要核苷或核苷酸类似物（NUC）或基于干扰素的治疗；基于干扰素的疗法可增加HBsAg下降和流失率。

    在6个月内HBsAg快速下降> 0.5 log10 IU / ml会导致NUC治疗期间HBsAg水平<100 IU / ml或HBsAg丢失。

    在持续应答者和在治疗结束后达到HBsAg <100 IU / ml的患者中停止NUC治疗可能会使5年期HBsAg损失增加> 30％。

    临床复发期间的HBsAg动力学有助于做出再治疗决定； HBsAg水平升高的患者需要重新治疗，而HBsAg水平降低的患者可能不需要重新治疗。