三頭勝於二：HBcrAg可作為HBV相關HCC的新預測因子

StephenW

Three Heads are Better than Two: HBcrAg as a New Predictor of HBV-related HCC
Jer-Wei Wu  1 , Jia-Horng Kao  1   2   3   4 , Tai-Chung Tseng  1   2   3
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.

    PMID: 33618507 DOI: 10.3350/cmh.2021.0012

Abstract

Patients with chronic hepatitis B virus (HBV) infection are at risk of developing hepatocellular carcinoma (HCC), and serum markers reflecting viral replication are potential predictors for HCC development. Besides the levels of serum HBV DNA and hepatitis B surface antigen (HBsAg), hepatitis B core-related antigen (HBcrAg) quantification is an emerging serological marker for viral replication. Unlike HBV DNA and HBsAg, HBcrAg is a covalently closed circular DNA-derived protein marker, consisting of hepatitis B e antigen (HBeAg), p22cr, and hepatitis B core antigen. In treatment-naïve HBV patients, higher HBcrAg levels are shown to be associated with an increased risk of HCC in several studies. More importantly, HBcrAg may complement HBV DNA level to predict HCC development. For example, an Asian treatment-naïve cohort study's data showed that HBcrAg level of 4 log U/mL was effective to stratify HCC risk in HBeAg-negative patients with intermediate viral loads, who may not need antiviral therapy because of the low to moderate risk of HCC. In patients receiving prolonged nucleos(t)ide analogue with profound viral suppression, most data indicated that HBV DNA and HBsAg levels no longer serve as HCC predictors. However, several studies suggested on-treatment HBcrAg levels may remain as an HCC predictor. In summary, HBcrAg level can be a useful biomarker for treatment-naïve patients, but its value in on-treatment patients needs validation. The next challenge is how to combine HBcrAg with the other viral markers to construct a better HCC prediction model, optimizing the management of HBV patients.

Keywords: HBV DNA; HBsAg; Hepatitis B virus; hepatitis B core-related antigen; hepatocelluar carcinoma.

StephenW

三頭勝於二：HBcrAg可作為HBV相關HCC的新預測因子
吳捷威1，高嘉鴻1 2 3 4，曾大中1 2 3
隸屬關係
隸屬關係

    1個
    國立台灣大學附屬醫院消化內科，消化內科，台灣台北。
    2
    國立台灣大學附屬醫院肝炎研究中心，台灣台北。
    3
    國立台灣大學醫院醫學研究室，台灣台北。
    4
    國立台灣大學醫學院臨床醫學研究所，台灣台北。

    PMID：33618507 DOI：10.3350 / cmh.2021.0012

抽象的

慢性乙型肝炎病毒（HBV）感染的患者有發展為肝細胞癌（HCC）的風險，反映病毒複製的血清標誌物可能是HCC發生的潛在預測因子。除了血清HBV DNA和乙型肝炎表面抗原（HBsAg）的水平外，乙型肝炎核心相關抗原（HBcrAg）的定量分析也是病毒複製的新興血清學標誌。與HBV DNA和HBsAg不同，HBcrAg是一種共價閉合的環狀DNA衍生蛋白標記，由乙型肝炎e抗原（HBeAg），p22cr和乙型肝炎核心抗原組成。在一些未經治療的HBV患者中，較高的HBcrAg水平與增加的HCC風險相關。更重要的是，HBcrAg可補充HBV DNA水平以預測HCC的發展。例如，一項亞洲未經治療的隊列研究數據顯示，HBcrAg水平為4 log U / mL可以有效地對中等病毒載量的HBeAg陰性患者進行HCC風險分層，因為中低風險可能不需要抗病毒治療HCC。在接受長時間的核苷酸（t）類似物並具有強大的病毒抑製作用的患者中，大多數數據表明HBV DNA和HBsAg水平不再充當HCC的預測指標。但是，一些研究表明，治療中的HBcrAg水平可能仍然是HCC的預測指標。總而言之，HBcrAg水平對於未接受過治療的患者可能是有用的生物標誌物，但其在接受治療的患者中的價值需要驗證。下一個挑戰是如何將HBcrAg與其他病毒標記物結合以構建更好的HCC預測模型，從而優化HBV患者的管理。

關鍵字：HBV DNA；乙肝表面抗原乙型肝炎病毒;乙肝核心相關抗原；肝細胞癌。

StephenW

https://www.e-cmh.org/upload/pdf/cmh-2021-0012.pdf