血清 M2BPGi 水平在预测慢性乙型肝炎病毒感染中晚期纤维化持

StephenW

血清 M2BPGi 水平在预测慢性乙型肝炎病毒感染中晚期纤维化持续性中的作用
麦龙宜 1 2 , 黄嘉豪 1 2 , 张嘉诚 1 3 , 许云轩 1 , 刘芬 4 , 冯志强 1 2 , Wai-Kay Seto 1 2 3 , Man-Fung Yuen 5 6
隶属关系
隶属关系

    1
    香港大学医学部，玛丽医院，薄扶林道 102 号，香港，中国。
    2
    香港大学肝脏研究国家重点实验室，中国香港。
    3
    香港大学深圳医院内科，中国深圳。
    4
    【作者单位】： 中山大学附属第一医院胃肠肝内科;
    5
    香港大学医学部，玛丽医院，薄扶林道 102 号，香港，中国。 [email protected]。
    6
    香港大学肝脏研究国家重点实验室，中国香港。 [email protected]。

    PMID：35258755 DOI：10.1007/s10620-022-07429-4

抽象的

背景：血清 mac-2 结合蛋白糖基化异构体 (M2BPGi) 是评估不同肝病患者肝纤维化的新标志物。对于慢性乙型肝炎感染（CHB），晚期纤维化或肝硬化是肝癌和肝功能失代偿的危险因素。我们旨在评估血清 M2BPGi 在预测慢性乙型肝炎患者晚期纤维化持续存在中的作用，尽管进行了有效的抗病毒治疗。

方法：前瞻性招募使用核苷（酸）类似物治疗≥3 年、丙氨酸氨基转移酶正常且血清HBV DNA 检测不到的CHB 晚期纤维化或肝硬化患者。在基线时使用瞬时弹性成像 (TE) 和 M2BPGi 测量评估肝纤维化，并在 3 年时重复。肝硬化 (LS) ≥ 9.0 kPa 和 ≥ 12.0 kPa 分别定义了晚期纤维化和肝硬化。

结果：共招募了 143 名患者（男：女 = 101:42；中位年龄 58.7 岁；53.8% 肝硬化）并完成配对评估。基线 LS 和 M2BPGi 的中值分别为 12.0 (IQR: 10.5-18.2) kPa 和 0.99 截止指数 (IQR: 0.75-1.74) (COI)，诊断 F3/F4 的一致性为 96%。尽管继续长期抗病毒治疗，96 名 (67.1%) 患者在 3 年时仍存在持续的晚期纤维化或肝硬化。在多变量分析中，基线 M2BPGi (OR 2.128, 95% CI 1.037-4.366) 和中心性肥胖 (OR 4.648, 95% CI 1.742-12.402) 与 3 年持续性晚期纤维化或肝硬化显着相关。基线 M2BPGi ≥ 1.265 COI 在预测 3 年持续性晚期纤维化或肝硬化方面具有 50.6% 的敏感性和 79.4% 的特异性（接受者操作特征曲线下面积：0.695）。中心性肥胖与基线 M2BPGi ≥ 1.265 COI 的存在与 95.7% 的患者在 3 年时出现持续性晚期纤维化或肝硬化相关。在随访期间观察到 5 名患者发生 HCC，并且与没有 HCC 的患者相比，血清 M2BPGi 水平的中位数增加更大（46% 对 6.2%，P = 0.038）。

结论：尽管进行了有效的抗病毒治疗，三分之二的慢性乙型肝炎患者仍观察到持续的晚期纤维化或肝硬化。高血清 M2BPGi 和中心性肥胖分别与持续性晚期纤维化或肝硬化风险增加超过两倍和四倍相关。

关键词：肝硬化；肝脂肪变性;乙型肝炎；肝纤维化;肥胖; VCTE。

© 2022。作者获得 Springer Science+Business Media, LLC 的独家许可，该公司隶属于 Springer Nature。

StephenW

Role of Serum M2BPGi Levels in Predicting Persistence of Advanced Fibrosis in Chronic Hepatitis B Virus Infection
Lung-Yi Mak  1   2 , Danny Ka-Ho Wong  1   2 , Ka-Shing Cheung  1   3 , Rex Wan-Hin Hui  1 , Fen Liu  4 , James Fung  1   2 , Wai-Kay Seto  1   2   3 , Man-Fung Yuen  5   6
Affiliations
Affiliations

    1
    Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road 102, Hong Kong, China.
    2
    State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China.
    3
    Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
    4
    Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
    5
    Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road 102, Hong Kong, China. [email protected].
    6
    State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China. [email protected].

    PMID: 35258755 DOI: 10.1007/s10620-022-07429-4

Abstract

Background: Serum mac-2-binding protein glycosylation isomer (M2BPGi) is a novel marker for liver fibrosis assessment in patients with different liver diseases. For chronic hepatitis B infection (CHB), advanced fibrosis or cirrhosis is a risk factor for liver cancer and hepatic decompensation. We aimed to assess the role of serum M2BPGi in prediction of persistence of advanced fibrosis in CHB patients despite potent antiviral therapy.

Methods: CHB patients with advanced fibrosis or cirrhosis who were put on nucleos(t)ide analogs for ≥ 3 years with normal alanine aminotransferase and undetectable serum HBV DNA were prospectively recruited. Assessment of liver fibrosis with transient elastography (TE) and M2BPGi measurements were performed at baseline and repeated at 3 years. Advanced fibrosis and cirrhosis were defined by liver stiffness (LS) ≥ 9.0 kPa and ≥ 12.0 kPa, respectively.

Results: A total of 143 patients (M:F = 101:42; median age 58.7 years; 53.8% cirrhotic) were recruited and completed paired assessment. The median value of baseline LS and M2BPGi were 12.0 (IQR: 10.5-18.2) kPa and 0.99 cut-off-index (IQR: 0.75-1.74) (COI), respectively, with 96% concordance for diagnosing F3/F4. Ninety-six (67.1%) patients had persistent advanced fibrosis or cirrhosis at 3 years despite continuation of long-term antiviral treatment. Upon multivariate analysis, baseline M2BPGi (OR 2.128, 95% CI 1.037-4.366) and presence of central obesity (OR 4.648, 95% CI 1.742-12.402) were significantly associated with persistent advanced fibrosis or cirrhosis at 3 years. Baseline M2BPGi ≥ 1.265 COI has 50.6% sensitivity and 79.4% specificity for predicting persistent advanced fibrosis or cirrhosis at 3 years (area under the receiver-operating characteristic curve: 0.695). The presence of central obesity in combination with baseline M2BPGi ≥ 1.265 COI was associated with 95.7% patients having persistent advanced fibrosis or cirrhosis at 3 years. HCC development was observed in five patients during follow-up and was associated with bigger median increase in the level of serum M2BPGi compared to patients without HCC (46% vs 6.2%, P = 0.038).

Conclusion: Persistent advanced fibrosis or cirrhosis was observed in two-thirds of CHB patients despite potent antiviral therapy. High serum M2BPGi and central obesity were associated with more than twofold and fourfold increase in risk of persistent advanced fibrosis or cirrhosis, respectively.

Keywords: Cirrhosis; Hepatic steatosis; Hepatitis B; Liver fibrosis; Obesity; VCTE.

© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.