AASLD2020[157]进行新的检查以改善表型 慢性肝炎的成人特征 B？

StephenW

157
DO NOVEL ASSAYS IMPROVE PHENOTYPIC
CHARACTERIZATION OF ADULTS WITH CHRONIC HEPATITIS
B?
Marc G. Ghany, Liver Diseases Branch, Nih, Wendy
King, Epidemiology, University of Pittsburgh; University of
Pittsburgh, Mauricio Lisker-Melman, Washington University
School of Medicine, Gavin Cloherty, Abbott Diagnostics,
Abbott Park, IL, USA, Mandana Khalili, Gastroenterology
and Hepatology, University of California San Francisco,
Raymond T. Chung, Liver Center, Gastroenterology
Division, Department of Medicine, Massachusetts General
Hospital, Norah Terrault, Division of Gastrointestinal and
Liver Diseases, University of Southern California, William M
Lee, Division of Digestive and Liver Diseases, University of
Texas Southwestern Medical Center, Daryl Lau, Division of
Gastroenterology and Hepatology, Beth Israel Deaconess
Medical Center, Harvard Medical School, Harry L.A. Janssen,
UHN, Anna S. Lok, University of Michigan, Richard K. Sterling,
Division of Gastroenterology, Hepatology and Nutrition,
Virginia Commonwealth University and on behalf of the HBRN
Background: Two novel markers, HBV RNA and hepatitis
B core-related antigen (HBcrAg), have been shown to
differentiate between phases of chronic hepatitis B (CHB) and
to predict therapeutic response However, prior studies were
limited by small sample size and incomplete representation
of all CHB clinical phases Aims: To examine levels of HBV
RNA and HBcrAg in adults across a range of phases of CHB
in a large North American cohort of adults with untreated/
recovered CHB Methods: Available serum samples meeting
criteria for HBeAg+ immune tolerant (IT), HBeAg+ immune
active (IA), HBeAg-neg IA, inactive carrier (IC) or HBsAgneg
phase were included HBV RNA was measured using
Abbott HBV pgRNA Research Assay (lower limit of detection
[LLOD] 1 65 IU/mL) and HBcrAg Fujirebio Lumipulse
Immunoassay (LLOD 1000 IU/mL) Spearman’s correlation
(r) quantified associations between markers. Results: 938
eligible participants (7% IT, 30% HBeAg+ IA, 28% HBeAg-
IA, 29% IC and 6% HBsAg-) with a median age of 41 years,
46% female, 79% Asian, 8% White, 11% Black and 3% other/
mixed race were included Genotype distribution: A-15%,
B-41%, C-36%, D-6% and E-2%; median HBV DNA 5 1 log10
IU/mL and median ALT 33 U/L. HBV RNA was quantifiable in
75% of participants (100% HBeAg+ and 61% HBeAg-); levels
differed across phases (Kruskal-Wallis p< 001; Figure)
HBV RNA highly correlated with HBV DNA (r = 96; p< 001)
and moderately with qHBsAg (r = 69; p< 001) HBcrAg was
quantifiable in 38% of participants (14% HBeAg+ and 53%
HBeAg-) and differed across phases (chi squared p< 001)
The majority of HBeAg+ participants (IT (82%) and eAg+ CHB
(87%)) had HBcrAg values above quantification (≥6.8 IU/mL);
the majority of HBeAg- CHB (62%) had values of 3-<5 IU/
mL, whereas the majority of IC (70%) and HBsAg- (88%) had
values <LLOD (<3 IU/mL) HBcrAg correlated highly with HBV
DNA (r= 91; p< 001) and moderately with qHBsAg (r= 66;
p< 001) Both HBV RNA and HBcrAg poorly correlated with
clinical indicators of disease activity (ALT: r= 55; p< 001 and
r= 53; p< 001, respectively) and disease severity (APRI: r
= 39; p< 001, and r= 40; p< 001, respectively; FIB-4: r =- 12;
p= 001/r=- 11; p= 002, respectively) Conclusion: Despite
a strong association of HBV RNA and HBcrAg with phases
of CHB and HBV DNA levels, these novel markers correlate
poorly with clinical indicators of disease activity, suggesting a
limited, incremental utility beyond currently used markers in
monitoring untreated patients.

StephenW

157
进行新的检查以改善表型
慢性肝炎的成人特征
B？
马克·加尼（Marc G.
匹兹堡大学流行病学国王；大学
匹兹堡，毛里西奥·利斯克·梅尔曼，华盛顿大学
医学院，加文·克洛赫蒂（Gavin Cloherty），雅培诊断，
美国伊利诺伊州雅培公园，胃肠病学Mandana Khalili
和加州大学旧金山分校的肝病
中华医学会肝病中心Raymond T. Chung
马萨诸塞州医学部医学科
诺拉·泰拉特医院胃肠道和疾病科
南加州大学肝病，威廉·M
Lee，University of University消化与肝病科
德州西南医学中心，刘德华
贝丝·以色列女执事肠胃病和肝病
哈佛医学院医学中心，哈里·扬·詹森，
UHN，Anna S. Lok，密歇根大学，Richard K. Sterling，
胃肠病学，肝病学和营养学系
弗吉尼亚联邦大学并代表HBRN
背景：两种新的标志物，HBV RNA和肝炎
B核相关抗原（HBcrAg）已显示
区分慢性乙型肝炎（CHB）和
预测治疗反应然而，先前的研究
受样本量小和代表不完整的限制
CHB临床所有阶段的目标：检查HBV水平
成人CHB各个阶段的RNA和HBcrAg
在北美大批成年人中，未经治疗/
回收的CHB方法：可用的血清样品符合要求
HBeAg +免疫耐受（IT）的标准，HBeAg +免疫
活性（IA），HBeAg阴性IA，惰性载体（IC）或HBsAgneg
包括HBV RNA
雅培HBV pgRNA研究测定（检测下限）
[LLOD] 1 65 IU / mL）和HBcrAg Fujirebio Lumipulse
免疫分析（LLOD 1000 IU / mL）Spearman相关性
（r）标记之间的量化关联。结果：938
合格的参与者（7％的IT，30％的HBeAg + IA，28％的HBeAg-
IA，29％的IC和6％的HBsAg-），平均年龄为41岁，
女性46％，亚洲79％，白人8％，黑人11％和其他3％/
基因型分布：A-15％，
B-41％，C-36％，D-6％和E-2％； HBV DNA中位数5 1 log10
IU / mL和中位ALT 33 U / L。 HBV RNA可定量
75％的参与者（100％HBeAg +和61％HBeAg-）；等级
跨阶段不同（Kruskal-Wallis p <001；图）
HBV RNA与HBV DNA高度相关（r = 96; p <001）
并以qHBsAg适度（r = 69; p <001）HBcrAg为
在38％的参与者中可量化（14％的HBeAg +和53％
HBeAg-），并且跨阶段有所不同（卡方p <001）
大部分HBeAg +参与者（IT（82％）和eAg + CHB
（87％））的HBcrAg值高于定量值（≥6.8IU / mL）；
大多数HBeAg-CHB（62％）的值在3- <5 IU /
mL，而大多数IC（70％）和HBsAg-（88％）含有
值<LLOD（<3 IU / mL）HBcrAg与HBV高度相关
DNA（r = 91; p <001）和中等水平的qHBsAg（r = 66;
p <001）HBV RNA和HBcrAg与
疾病活动的临床指标（ALT：r = 55； p <001和
r = 53；分别为p <001）和疾病严重程度（APRI：r
= 39; p <001，且r ＝ 40； p <001，分别； FIB-4：r =-12；
p = 001 / r =-11; p = 002）结论：尽管
HBV RNA和HBcrAg与阶段密切相关
CHB和HBV DNA水平的变化，这些新的标志物相关
疾病活动的临床指标较差，提示
有限的增量实用程序，超出了当前使用的标记
监测未经治疗的患者。