乙型肝炎核心抗体和肝硬度测量值可预测HBeAg阳性的慢性乙型

StephenW

Clin Exp Med. 2020 Feb 12. doi: 10.1007/s10238-019-00603-5. [Epub ahead of print]
Hepatitis B core antibody and liver stiffness measurements predict HBeAg seroconversion in HBeAg-positive chronic hepatitis B patients with minimally elevated alanine aminotransferase (ALT) levels.
Fu X1, Lou H1, Chen F1, Gao X2, Lin Z3.
Author information

1
    Department of Infectious Diseases and Hepatology Unit, Panyu Central Hospital, Guangzhou, Guangdong, China.
2
    Department of Hepatology, Huizhou Municipal Central Hospital, Huizhou, Guangdong, China. [email protected].
3
    Department of Hepatology, Huizhou Municipal Central Hospital, Huizhou, Guangdong, China. [email protected].

Abstract

Alanine aminotransferase (ALT) levels between 1 and 2 times the upper limit of normal (ULN) are common in patients with chronic hepatitis B (CHB) infection. There are few clinical studies focused on this group of patients because of the poorer treatment outcomes compared to those with more than 2 × ULN ALT level. However, treatments are necessary to reduce liver damage for patients with minimally elevated ALT levels. And biomarkers are needed in predicting the treatment response. In this study, a total of 106 patients with CHB were enrolled and treated with entecavir, telbivudine or tenofovir disoproxil fumarate. Liver stiffness was measured by transient elastography, and quantitative levels of hepatitis B core antibody (HBcAb) were detected by ELISA. At week 96, 31 (29.25%) patients achieved hepatitis B e antigen (HBeAg) seroconversion. Notably, baseline HBcAb levels and liver stiffness measurements (LSM) were higher in patients who achieved HBeAg seroconversion. The multivariate analysis showed that the baseline HBcAb levels and LSM were independent predictors for HBeAg seroconversion. The area under receiver operating characteristic curve of baseline HBcAb, LSM and the combination of them for HBeAg seroconversion was 0.714, 0.720 and 0.717, respectively. In addition, we discovered that the patients with baseline HBcAb levels ≥ 4.15 log10 IU/mL and LSM ≥ 9.85 kPa had higher rates of HBeAg seroconversion. Therefore, the measurement of HBcAb and liver stiffness might be good approaches for the optimization of antiviral therapy for HBeAg-positive CHB patients with minimally elevated ALT levels.
KEYWORDS:

Chronic hepatitis B; Hepatitis B core antibody; Liver stiffness measurement; Minimally elevated ALT levels

PMID:
    32052245
DOI:
    10.1007/s10238-019-00603-5

StephenW

临床Exp Med。 2020年2月12日。doi：10.1007 / s10238-019-00603-5。 [Epub提前发行]
乙型肝炎核心抗体和肝硬度测量值可预测HBeAg阳性的慢性乙型肝炎患者的丙氨酸氨基转移酶（ALT）水平最低，HBeAg血清转化。
傅X1，楼H1，陈F1，高X2，林Z3。
作者信息

1个
    广州市番yu市中心医院传染病与肝病科。
2
    惠州市人民医院肝病科，广东惠州。 [email protected]。
3
    惠州市中心医院肝科，广东惠州。 [email protected]。

抽象

慢性乙型肝炎（CHB）感染患者的丙氨酸氨基转移酶（ALT）水平通常是正常上限（ULN）的1至2倍。很少有针对此类患者的临床研究，因为与ULN ALT水平高于2x×的患者相比，治疗效果较差。但是，对于降低ALT水平最低的患者，必须采取治疗措施以减少肝脏损害。并且在预测治疗反应中需要生物标记。在这项研究中，共纳入106名CHB患者，并接受恩替卡韦，替比夫定或替诺福韦富马酸替诺福韦酯治疗。通过瞬时弹性成像测量肝硬度，并通过ELISA检测乙肝核心抗体（HBcAb）的定量水平。在第96周，有31名（29.25％）患者获得了乙型肝炎e抗原（HBeAg）血清转化。值得注意的是，实现HBeAg血清转换的患者的基线HBcAb水平和肝硬度测量值（LSM）较高。多元分析表明，基线HBcAb水平和LSM是HBeAg血清转化的独立预测因子。基线HBcAb，LSM及其对HBeAg血清转化的组合在接受者工作特征曲线下的面积分别为0.714、0.720和0.717。此外，我们发现基线HBcAb水平≥4.15log10 IU / mL和LSM≥≥9.85kPa的患者HBeAg血清转化率更高。因此，对于ALT水平最低程度升高的HBeAg阳性CHB患者，测量HBcAb和肝硬度可能是优化抗病毒治疗的好方法。
关键字：

慢性乙型肝炎；乙型肝炎核心抗体；肝硬度测量；最低程度地提高ALT水平

PMID：
    32052245
DOI：
    10.1007 / s10238-019-00603-5