Serum hepatitis B core-related antigen level stratifies risk of disease progression in chronic hepatitis B patients with intermediate viral load
Tai-Chung TsengChun-Jen LiuYang Wan-TingYang Wan-TingJia-Horng KaoJia-Horng Kao
January 2021Alimentary Pharmacology & Therapeutics
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.作者: StephenW 时间: 2021-1-30 15:31
DOI：10.1111 / apt.16266
抽象
背景：患有慢性乙型肝炎病毒（HBV）的患者有患肝病的风险。血清乙肝核心相关抗原（HBcrAg）是用于HBV复制的肝内模板的新生物标记。目的：探讨高HBcrAg水平是否与肝硬化风险增加有关，尤其是由于中度疾病进展风险而具有中等病毒载量（HBV DNA 2000-19 999 IU / mL）的患者。方法：总共纳入了1673例初治，非肝硬化，基线时小于40 U / L的乙型肝炎e抗原（HBeAg）和丙氨酸转氨酶（ALT）的患者。我们探讨了所有患者中HBcrAg基线水平与肝硬化发展之间的关系，以及中度病毒载量者中更高的HBcrAg水平（<10 vs≥10KU / mL）是否与疾病进展风险增加相关。结果：在1673名患者中，有104名在平均随访15.9年后发展为肝硬化。较高的HBcrAg水平与肝硬化，肝硬化相关并发症和肝相关死亡的发生率增加相关。在445名中度病毒载量患者中，以HBcrAg水平为10 KU / mL分层的肝硬化风险产生的危险比为3.22（95％CI：1.61-6.47）。探索其他肝硬化前终点时（包括HBeAg阴性肝炎，肝炎爆发和HBV DNA> 20000 IU / mL），风险分层仍然很重要。结论：在ALT水平正常的HBeAg阴性患者中，较高的HBcrAg水平与肝硬化风险增加相关。在中等病毒载量的人群中，HBcrAg <10 KU / mL定义为疾病进展的低风险人群。