血清乙型肝炎核心相关抗原水平可将中度病毒载量的慢性乙

StephenW

Serum hepatitis B core-related antigen level stratifies risk of disease progression in chronic hepatitis B patients with intermediate viral load
Tai-Chung Tseng  1   2   3 , Chun-Jen Liu  1   2   4 , Wan-Ting Yang  2 , Chen-Yang Hsu  5 , Chun-Ming Hong  1   6 , Tung-Hung Su  1   2 , Cheng-Hsueh Tsai  2 , Chi-Ling Chen  4 , Hung-Chih Yang  1   2   4   7 , Chen-Hua Liu  1   2 , Hsiu-Hsi Chen  5 , Pei-Jer Chen  1   2   4 , Jia-Horng Kao  1   2   3   4
Affiliations
Affiliations

    1
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
    2
    Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
    3
    Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
    4
    Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine Taipei, Taiwan.
    5
    Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
    6
    Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
    7
    Department of Microbiology, National Taiwan University College of Medicine Taipei, Taiwan.

    PMID: 33465271 DOI: 10.1111/apt.16266

Abstract

Background: Patients with chronic hepatitis B virus (HBV) infection are at risk of developing liver disease. Serum hepatitis B core-related antigen (HBcrAg) is a new biomarker for intrahepatic templates for HBV replication.

Aim: To explore whether a high HBcrAg level is associated with increased risk of cirrhosis, especially in patients with intermediate viral load (HBV DNA 2000-19 999 IU/mL) due to their moderate risk of disease progression.

Methods: A total of 1673 treatment-naïve, non-cirrhotic patients with negative hepatitis B e antigen (HBeAg) and alanine aminotransferase (ALT) level <40 U/L at baseline were enrolled. We explored the relationship between baseline levels of HBcrAg and cirrhosis development in all patients, and whether a higher HBcrAg level (<10 vs ≥10 KU/mL) was associated with an increased risk of disease progression in those with intermediate viral load.

Results: Of the 1673 patients, 104 developed cirrhosis after a mean follow-up of 15.9 years. Higher HBcrAg levels were associated with increased incidence of cirrhosis, cirrhosis-related complications, and liver-related death. In 445 patients with intermediate viral load, the cirrhosis risk stratified by HBcrAg level of 10 KU/mL yielded a hazard ratio of 3.22 (95% CI: 1.61-6.47). The risk stratification remained significant when exploring other pre-cirrhosis endpoints, including HBeAg-negative hepatitis, hepatitis flare, and HBV DNA >20 000 IU/mL after 3 years of follow-up.

Conclusions: In HBeAg-negative patients with normal ALT levels, higher HBcrAg levels are associated with increased risk of cirrhosis. Among those with intermediate viral load, HBcrAg <10 KU/mL defines a low-risk group for disease progression.

© 2021 John Wiley & Sons Ltd.