乙型肝炎表面抗原，核心相关抗原和HBV RNA：预测NA治疗中断

StephenW

Hepatitis B Surface Antigen, Core-Related Antigen, and HBV RNA: Predicting Clinical Relapse after NA Therapy Discontinuation
Apichat Kaewdech  1 , Pisit Tangkijvanich  2 , Pimsiri Sripongpun  1 , Teepawit Witeerungrot  3 , Sawangpong Jandee  1 , Tanaka Yasuhito  4 , Teerha Piratvisuth  1   3
Affiliations
Affiliations

    1
    Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
    2
    Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
    3
    NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Songkhla, Thailand.
    4
    Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

    PMID: 32668074 DOI: 10.1111/liv.14606

Abstract

Background & aims: The safe discontinuation of nucleos(t)ide analogue therapy remains challenging in chronic hepatitis B. We investigated the potential role of quantitative hepatitis B surface antigen, hepatitis B core-related antigen, and hepatitis B virus RNA at the end of treatment in predicting off-therapy relapse.

Methods: Patients who fulfilled the stopping criteria of the Asian Pacific Association for the Study of the Liver guideline were enrolled. Virological relapse was defined as hepatitis B virus DNA level greater than 2000 IU/mL, and clinical relapse was defined as virological relapse plus alanine aminotransferase level of more than twice the upper limit of normal.

Results: Ninety-two patients participated. The combination of end of treatment hepatitis B core-related antigen and hepatitis B virus RNA levels was most predictive of clinical relapse. Multivariate analysis revealed that end of treatment hepatitis B core-related antigen and hepatitis B virus RNA were independently associated with clinical relapse. During follow-up, no patients with undetectable hepatitis B core-related antigen (<3.0 log10 U/mL) and hepatitis B virusRNA (<2.0 log10 copies/mL) at end of treatment developed clinical relapse, in comparison with 22.9% and 62.5% patients with detectable levels of one or both biomarkers, respectively. End of treatment quantitative hepatitis B surface antigen was linked to a likelihood of hepatitis B surface antigen clearance.

Conclusions: The combined hepatitis B core-related antigen and hepatitis B virus RNA assays at end of treatment were highly predictive of subsequent clinical relapse. These novel biomarkers could potentially be used to identify patients who could safely discontinue nucleos(t)ide analogue therapy.

Keywords: Hepatitis B Core antigen; Hepatitis B RNA; Hepatitis B surface antigen; Relapse.

StephenW

乙型肝炎表面抗原，核心相关抗原和HBV RNA：预测NA治疗中断后的临床复发
Apichat Kaewdech 1，Pisit Tangkijvanich 2，Pimsiri Sripongpun 1，Teepawit Witeerungrot 3，Sawangpong Jandee 1，Tanaka Yasuhito 4，Teerha Piratvisuth 1 3
隶属关系
隶属关系

    1个
    泰国宋卡府宋卡王子大学医学院内科胃肠病学和肝病科。
    2
    泰国曼谷朱拉隆功大学医学院肝炎和肝癌卓越中心。
    3
    泰国宋卡府宋卡兰加林医院NKC胃肠病和肝病研究所。
    4
    名古屋市立大学医学研究科病毒学和肝脏科，日本名古屋。

    PMID：32668074 DOI：10.1111 / liv.14606

抽象

背景与目的：在慢性乙型肝炎中安全终止核苷酸类似物疗法仍然具有挑战性。我们研究了定量乙肝表面抗原，乙肝核心相关抗原和乙肝病毒RNA的潜在作用。预测非治疗复发的治疗。

方法：纳入符合亚太研究肝脏指南协会停止标准的患者。病毒学复发定义为乙型肝炎病毒DNA含量大于2000 IU / mL，临床复发定义为病毒学复发加上丙氨酸转氨酶水平超过正常上限的两倍。

结果：92例患者参加。治疗结束时乙肝核心相关抗原和乙肝病毒RNA水平的组合最能预测临床复发。多因素分析显示，治疗结束时乙肝核心相关抗原和乙肝病毒RNA与临床复发独立相关。在随访过程中，治疗结束时未检测到乙型肝炎核心相关抗原（<3.0 log10 U / mL）和乙型肝炎病毒RNA（<2.0 log10拷贝/ mL）的患者未出现临床复发，相比之下，分别为22.9％和62.5％分别检测到一种或两种生物标志物水平的患者百分比。治疗结束时定量乙肝表面抗原与乙肝表面抗原清除的可能性有关。

结论：治疗结束时联合使用乙型肝炎核心相关抗原和乙型肝炎病毒RNA检测可高度预测随后的临床复发。这些新颖的生物标记物可潜在地用于识别可以安全地终止核苷酸类似物治疗的患者。

关键词：乙型肝炎核心抗原乙型肝炎RNA；乙型肝炎表面抗原；复发。