新型病毒标记物和慢性乙型肝炎患者治疗后复发的预测：系

StephenW

Novel Viral Markers and the Prediction of Off-treatment Relapse in Chronic Hepatitis B Patients: A Systematic Review
Aunchalee Jaroenlapnopparat  1 , Maneerat Chayanupatkul  1 , Pisit Tangkijvanich  2
Affiliations
Affiliations

    1
    Alternative and Complementary Medicine for Gastrointestinal and Liver Diseases Research Unit, Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
    2
    Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

    PMID: 33811375 DOI: 10.1111/jgh.15516

Abstract

Background: Hepatitis B core-related antigen (HBcrAg) and hepatitis B virus RNA (HBV RNA) are novel markers that reflect intrahepatic cccDNA and could be useful in the prediction of relapse after nucleos(t)ide analogues (NA) discontinuation.

Aim: To perform a systematic review on this issue.

Methods: Medline/Pubmed database was searched using text terms related to HBcrAg, RNA, NAs, discontinuation, and relapse. Included studies were those that enrolled adult patients who had been on NAs for more than 6 months with available information on end-of-treatment (EOT) HBcrAg and/or HBV RNA and relapse rates.

Results: Sixteen studies were included. Virological and clinical relapse rates ranged from 11-100% and 11-73%, respectively. Low or undetectable EOT HBcrAg levels were associated with low off-treatment relapse rates in most studies with area under the receiver operating characteristic curve (AUROC) of 0.69-0.70 for predicting virological relapse (VR) and 0.61-0.77 for predicting clinical relapse (CR). Undetectable EOT HBV RNA was associated with a lower risk of off-treatment relapse with AUROC of 0.65-0.76 for predicting VR and 0.66-0.73 for predicting CR. Combined EOT HBcrAg and HBV RNA performed better in predicting off-treatment relapse than either test alone with AUROC of 0.816-0.846 for predicting CR. None of the patients with double negative HBV RNA and HBcrAg developed clinical relapse.

Conclusion: Combining HBcrAg with HBV RNA or HBsAg improved the discriminating abilities in the prediction of off-treatment relapse of each test. Patients with double-negative HBcrAg and HBV RNA at EOT had low risks of relapse and could be considered for NA discontinuation.

Keywords: Chronic hepatitis B; Hepatitis B core-related antigen; Hepatitis B virus RNA; Nucleos(t)ide analogues; Relapse.

This article is protected by copyright. All rights reserved.

StephenW

新型病毒标记物和慢性乙型肝炎患者治疗后复发的预测：系统评价
Aunchalee Jaroenlapnopparat 1，Maneerat Chayanupatkul 1，Pisit Tangkijvanich 2
隶属关系
隶属关系

    1个
    泰国曼谷朱拉隆功大学医学院生理学系胃肠道和肝脏疾病的替代和补充医学研究室。
    2个
    泰国曼谷朱拉隆功大学医学院肝炎和肝癌卓越中心。

    PMID：33811375 DOI：10.1111 / jgh.15516

抽象的

背景：乙型肝炎核心相关抗原（HBcrAg）和乙型肝炎病毒RNA（HBV RNA）是反映肝内cccDNA的新型标记，可用于预测核苷酸类似物（NA）停用后的复发。

目的：对此问题进行系统的审查。

方法：使用与HBcrAg，RNA，NAs，停药和复发相关的文本术语搜索Medline / Pubmed数据库。纳入的研究包括那些接受了超过6个月的NAs治疗的成年患者，并获得了有关治疗结束（EOT）HBcrAg和/或HBV RNA以及复发率的可用信息。

结果：包括十六项研究。病毒学和临床复发率分别为11-100％和11-73％。在大多数研究中，低或不可检测的EOT HBcrAg水平与低的治疗复发率相关，预测病毒学复发（VR）的受试者工作特征曲线（AUROC）为0.69-0.70，预测临床复发（CR）的受试者为0.61-0.77 ）。无法检测到的EOT HBV RNA与较低的治疗后复发风险相关，预测VR的AUROC为0.65-0.76，预测CR的为0.66-0.73。结合EOT HBcrAg和HBV RNA预测非治疗性复发的效果优于任一试验，AUROC为0.816-0.846预测CR。 HBV RNA和HBcrAg双重阴性的患者均未出现临床复发。

结论：将HBcrAg与HBV RNA或HBsAg结合使用可提高区分每个测试的治疗后复发的能力。 EOT时HBcrAg和HBV RNA双阴性的患者复发风险低，可以考虑停药。

关键字：慢性乙型肝炎；乙肝核心相关抗原；乙型肝炎病毒RNA；核苷类似物；复发。

本文受版权保护。版权所有。