Incidence and prediction of HBsAg seroclearance in a prospective multi-ethnic HBeAg-negative chronic hepatitis B cohort.
Incidence and prediction of HBsAg seroclearance in a prospective multi-ethnic HBeAg-negative chronic hepatitis B cohort.
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DOI：
10.1002/hep.32231
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Janssen HLA
中科院分区：
文献类型：
--
作者：
Terrault NA;Wahed AS;Feld JJ;Cooper SL;Ghany MG;Lisker-Melman M;Perrillo R;Sterling RK;Khalili M;Chung RT;Rosenthal P;Fontana RJ;Sarowar A;Lau DTY;Wang J;Lok AS;Janssen HLA
实现HBsAg丢失是慢性B型肝炎自然史的一个重要里程碑。一个更个性化的方法来预测HBsAg丢失是相关的，在治疗患者。本研究旨在基于定量HBsAg水平和其他基线特征开发和验证HBsAg丢失的预测模型。B型肝炎研究网络（HBRN）是一项前瞻性队列研究，包括1240名未经治疗的HBeAg阴性患者（1150名成人，90名儿童），中位随访时间为5.5年。确定HBsAg丢失和抗-HBs获得的发生率，并使用现成的变量开发和外部验证HBsAg丢失的预测评分。HBsAg丢失和抗-HBs获得的粗发生率分别为1.6和1.1/100人-年（PY）; 67例达到持续HBsAg丢失，发生率为1.2/100 PY。HBsAg丢失增加与年龄较大、非亚洲人种、HBV表型（非活动性携带者vs其他）、HBV基因型A、HBV DNA水平较低以及HBsAg定量（ΔqHBsAg）变化较低和较大显著相关。HBRN-SQuARe（性别、ΔquantHBsAg、年龄、人种）评分预测1年和3年时HBsAg随时间的丢失，AUROC（95%置信区间）分别为0.99（95% CI：0.987-1.00）和0.95（95% CI 0.91-1.00）。在另一组1253例HBeAg阴性患者中进行验证，中位随访时间为3.1年，HBRN-SQuARe预测1年和3年时HBsAg丢失，AUROC值分别为0.99 [0.98-1.00]和0.88 [0.77-0.99]。使用一个简单有效的评分（HBRN-SQuARe）可以准确预测3年内未接受治疗的HBeAg阴性慢性B肝炎患者的HBsAg丢失。这种诊断工具可用于支持患者护理和咨询。
Achieving HBsAg loss is an important landmark in the natural history of chronic hepatitis B. A more personalized approach to prediction of HBsAg loss is relevant in couseling patients. This study sought to develop and validate a prediction model for HBsAg loss based on quantitative HBsAg levels and other baseline characteristics. Hepatitis B Research Network (HBRN) is a prospective cohort including 1240 untreated HBeAg-negative patients (1150 adults, 90 children) with median follow-up of 5.5 years. Incidence rates of HBsAg loss and anti-HBs acquisition were determined and a predictor score of HBsAg loss using readily available variables was developed and externally validated. Crude incidence rates of HBsAg loss and anti-HBs acquisition were 1.6 and 1.1 per 100 person-years (PY); 67 achieved sustained HBsAg loss for an incidence rate of 1.2 per 100 PY. Increased HBsAg loss was significantly associated with older age, non-Asian race, HBV phenotype (inactive carrier vs others), HBV genotype A, lower HBV DNA levels and lower and greater change in quantitative HBsAg (ΔqHBsAg). The HBRN-SQuARe (sex,ΔquantHBsAg, age, race) score predicted HBsAg loss over time with AUROC (95% confidence intervals) at 1 and 3 years of 0.99 (95% CI: 0.987–1.00) and 0.95 (95% CI 0.91–1.00), respectively. Validation in another cohort of 1253 HBeAg-negative patients with median follow-up of 3.1 years, HBRN-SQuARe predicted HBsAg loss at 1 and 3 years with AUROC values of 0.99 [0.98–1.00] and 0.88 [0.77–0.99], respectively. HBsAg loss in predominantly untreated patients with HBeAg-negative chronic hepatitis B can be accurately predicted over a 3-year horizon using a simple validated score (HBRN-SQuARe). This prognostication tool can be used to support patient care and counseling.
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