乙型肝炎表面抗原血清清除的HBV患者的长期结果

StephenW

SUMMARY AND COMMENT | GASTROENTEROLOGY, INFECTIOUS DISEASES

June 3, 2020

Long-Term Outcomes in HBV Patients with Hepatitis B Surface Antigen Seroclearance

Atif Zaman, MD, MPH reviewing Anderson RT et al. Clin Gastroenterol Hepatol 2020 May 27

A meta-analysis supports use of seroclearance as a surrogate endpoint for improved clinical outcomes in patients with chronic HBV infection.

The treatment target for chronic hepatitis B virus (HBV) infection is hepatitis B surface antigen (HBsAg) seroclearance. However, the strength of the association between HBsAg seroclearance and improvement in long-term clinical outcomes is unclear.

To address this issue, researchers conducted a systematic review and meta-analysis, identifying 28 studies that assessed outcomes in nearly 190,000 HBV-infected patients with recorded HBsAg status. Long-term outcomes studied included hepatocellular carcinoma (HCC), hepatic decompensation, liver transplantation, and all-cause mortality. In the meta-analysis, random effects modeling was performed to calculate rate ratios.

During nearly 1.5 million person-years of follow-up, the incidence of any clinical event listed above was lower in those with HBsAg seroclearance compared with those with HBsAg persistence (0.2/1000 person-years vs. 2.5/1000 person-years). Pooled rate ratios indicated significantly reduced incidence for each clinical outcome in the seroclearance group versus the persistence group: 0.3 for HCC, 0.3 for hepatic decompensation, and 0.2 for liver transplantation and/or death. Interstudy heterogeneity was low, indicating consistency of results across studies.
Comment

This meta-analysis confirms that achieving seroclearance not only consistently improves liver-related outcomes in patients with HBV but also reduces mortality. Therefore, this study supports the use of HBsAg seroclearance as a valid surrogate marker for improved clinical outcomes.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Editor Disclosures at Time of Publication

Disclosures for Atif Zaman, MD, MPH at time of publication

Grant/Research Support
       

Merck

Citation(s):

Anderson RT et al. Association between seroclearance of hepatitis B surface antigen and long-term clinical outcomes of patients with chronic HBV infection: Systematic review and meta-analysis. Clin Gastroenterol Hepatol 2020 May 27; [e-pub]. (https://doi.org/10.1016/j.cgh.2020.05.041)

StephenW

摘要和评论|肠胃病，传染病

2020年6月3日

乙型肝炎表面抗原血清清除的HBV患者的长期结果

Atif Zaman，医学博士，MPH评论了Anderson RT等。 Castro Gastroenterol Hepatol 2020年5月27日

一项荟萃分析支持使用血清清除率作为替代终点，以改善慢性HBV感染患者的临床结局。

慢性乙型肝炎病毒（HBV）感染的治疗目标是乙型肝炎表面抗原（HBsAg）血清清除。但是，尚不清楚HBsAg血清清除与长期临床结果改善之间的关联强度。

为了解决这个问题，研究人员进行了系统的回顾和荟萃分析，确定了28项研究，评估了近190,000例记录了HBsAg状态的HBV感染患者的结局。研究的长期结局包括肝细胞癌（HCC），肝失代偿，肝移植和全因死亡率。在荟萃分析中，进行了随机效应建模以计算比率。

在将近150万人年的随访中，与HBsAg持续存在者相比，HBsAg血清清除率高于上述任何临床事件的发生率（0.2 / 1000人年vs. 2.5 / 1000人年）。合并比率表明，血清清除组与持久性组相比，每种临床结局的发生率均显着降低：HCC为0.3，肝失代偿为0.3，肝移植和/或死亡为0.2。研究间异质性较低，表明各研究结果的一致性。
评论

这项荟萃分析证实，达到血清清除率不仅可以持续改善HBV患者的肝脏相关结局，还可以降低死亡率。因此，这项研究支持使用HBsAg血清清除率作为改善临床结局的有效替代指标。
读者注意：在我们审阅本文时，其出版者指出，本文尚未定稿，可以进行后续更改。

出版时的编辑披露

出版时有关Atif Zaman，MD，MPH的披露

资助/研究支持
的

默克

引文：

安德森RT等。乙型肝炎表面抗原的血清清除与慢性HBV感染患者的长期临床结局之间的关联：系统评价和荟萃分析。 Castro Gastroenterol Hepatol 2020年5月27日； [e-pub]。 （https：///doi.org/10.1016/j.cgh.2020.05.041）