血清前基因组 RNA 结合乙型肝炎核心相关抗原有助于预测慢性

StephenW

血清前基因组 RNA 结合乙型肝炎核心相关抗原有助于预测慢性乙型肝炎患者停用核苷（酸）类似物后病毒学复发的风险
王发达 1 2 , 周静 1 , 李兰青 1 , 王梦兰 1 , 亚曹 1 , 王永红 1 , 张冬梅 1 , 陈恩强 1
隶属关系
隶属关系

    1
    【作者单位】： 四川大学华西医院传染病中心;
    2
    【作者单位】： 成都市第三人民医院感染科;

    PMID：35814664 PMCID：PMC9257105 DOI：10.3389/fmicb.2022.901233

抽象的

背景和目的：在慢性乙型肝炎（CHB）患者中停止核苷（酸）类似物（NAs）治疗并不常见。虽然一些指南中出现了停用标准，但评估停用 NA 的指标有限，是否可以安全停用 NA 仍然是一个棘手的临床问题。我们的研究旨在探讨治疗结束（EOT）时血清前基因组 RNA（pgRNA）和乙型肝炎核心相关抗原（HBcrAg）在指导 CHB 患者安全停用 NA 中的作用。

方法：本研究为回顾性研究，收集2020年6月至2021年1月在华西医院停止NAs治疗的所有CHB患者的临床资料，包括EOT pgRNA、HBcrAg、乙型肝炎表面抗原（HBsAg）等。符合亚太地区停药指南。观察 NAs 停用 1 年期间的病毒学复发 (VR) 率，并分析 EOT pgRNA、HBcrAg 和 VR 之间的关系。

结果：本研究共招募了 64 名患者，其中 33 名（51.5%）患者在 1 年内经历了 VR。 EOT pgRNA 阳性 (OR = 14.59, p = 0.026) 和 EOT 较高的 HBcrAg 水平 (OR = 14.14, p = 0.001) 是 VR 的独立危险因素。 VR 的 EOT HBcrAg 的接受者操作特征 (AUROC) 值下面积为 0.817 (p < 0.001)，最佳截断值为 3.3 log10 U/mL。 EOT pgRNA 阳性和 EOT HBcrAg >3.3 log10 U/mL 的患者在停用 NA 后更有可能出现 VR（88.9% 对 45.5%，p = 0.027）。

结论：根据目前的指南，NAs 停止后 VR 发生率较高。 EOT pgRNA 阳性和更高的 HBcrAg 水平带来更高的 VR 风险。结合这些新的标志物可以更好地帮助我们评估患者是否可以安全地停止 NAs 治疗。

关键词：慢性乙型肝炎；停产；乙型肝炎核心相关抗原；核苷（酸）类似物；前基因组 RNA。

版权所有 © 2022 王、周、李、王、陶、王、张和陈。

StephenW

Serum Pregenomic RNA Combined With Hepatitis B Core-Related Antigen Helps Predict the Risk of Virological Relapse After Discontinuation of Nucleos(t)ide Analogs in Patients With Chronic Hepatitis B
Fa-Da Wang  1   2 , Jing Zhou  1 , Lan-Qing Li  1 , Meng-Lan Wang  1 , Ya-Cao Tao  1 , Yong-Hong Wang  1 , Dong-Mei Zhang  1 , En-Qiang Chen  1
Affiliations
Affiliations

    1
    Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.
    2
    Department of Infectious Disease, Chengdu Third People's Hospital, Chengdu, China.

    PMID: 35814664 PMCID: PMC9257105 DOI: 10.3389/fmicb.2022.901233

Abstract

Background and aim: Cessation of nucleos(t)ide analogs (NAs) therapy in patients with chronic hepatitis B (CHB) is uncommon. Although criteria for discontinuation appear in some guidelines, the indicators for assessing discontinuation of NAs are limited, whether NAs can be safely ceased remains a difficult clinical issue. Our study aimed to investigate the role of serum pregenomic RNA (pgRNA) and hepatitis B core-related antigen (HBcrAg) at the end of treatment (EOT) in guiding the safe discontinuation of NAs in CHB patients.

Methods: This is a retrospective study, clinical data of all CHB patients who discontinued NAs treatment at West China Hospital between June 2020 and January 2021 were collected, including EOT pgRNA, HBcrAg, hepatitis B surface antigen (HBsAg), etc. All patients should meet the Asian-Pacific guideline for discontinuation. Observing virological relapse (VR) rates during 1 year of NAs discontinuation and analyzing the relationship between EOT pgRNA, HBcrAg, and VR.

Results: A total of 64 patients were enrolled in this study and 33 (51.5%) patients experienced VR in 1 year. EOT pgRNA positivity (OR = 14.59, p = 0.026) and EOT higher HBcrAg levels (OR = 14.14, p = 0.001) were independent risk factors for VR. The area under the receiver-operating characteristic (AUROC) value of EOT HBcrAg for VR was 0.817 (p < 0.001), optimal cut-off value was 3.3 log10 U/mL. Patients with EOT pgRNA positivity and EOT HBcrAg >3.3 log10 U/mL were more likely to experience VR after discontinuation of NAs (88.9 vs. 45.5%, p = 0.027).

Conclusion: According to current guidelines, a higher VR rate occurs after cessation of NAs. EOT pgRNA positivity and higher HBcrAg level carries a higher risk of VR. Combining these novel markers can better help us assess whether patients can safely cease NAs treatment.

Keywords: chronic hepatitis B; discontinuation; hepatitis B core-associated antigen; nucleos(t)ide analogs; pregenomic RNA.

Copyright © 2022 Wang, Zhou, Li, Wang, Tao, Wang, Zhang and Chen.

StephenW

https://doi.org/10.3389/fmicb.2022.901233