Quantification of HBsAg to predict low levels and seroclearance in HBeAg-negative patients receiving nucleos(t)ide analogues.
Quantification of HBsAg to predict low levels and seroclearance in HBeAg-negative patients receiving nucleos(t)ide analogues.
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DOI：
10.1371/journal.pone.0188303
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Carrión JA
中科院分区：
文献类型：
--
作者：
Broquetas T;Garcia-Retortillo M;Hernandez JJ;Puigvehí M;Cañete N;Coll S;Cabrero B;Giménez MD;Solà R;Carrión JA
HBeAg阴性的慢性B型肝炎患者需要长期使用核苷（酸）类似物（NAs），因为表面抗原（HBsAg）丢失是不常见的。低定量HBsAg（qHBsAg）水平可识别血清清除概率较高的患者。本研究的目的是评估接受NAs的HBeAg阴性患者的qHBsAg，以预测HBsAg水平的降低和血清清除。在NAs治疗前和治疗1、3、5、8年及以上时，HBeAg阴性患者qHBsAg的回顾性分析。从1999年到2015年，对95名HBeAg阴性患者的358份血清样本进行了HBsAg定量。在基线或随访期间，14%的患者qHBsAg（<120 IU/mL）较低，4%的患者HBsAg丢失。没有基线变量预测血清清除，只有治疗持续时间预测低qHBsAg。qHBsAg的年下降率为-0.102 log IU/mL，至HBsAg丢失的中位时间为6.04年。HBsAg水平低的患者（-0.257）的下降幅度大于HBsAg水平低的患者（-0.057）（p<0.001）。第3年qHBsAg delta的诊断准确性（ROC曲线，95%CI）为0.89（0.81-0.97），临界值>0.3 log IU/mL显示阳性和阴性预测值分别为42%和100%，以识别HBsAg水平较低的患者。在接受NAs的HBeAg阴性患者中，qHBsAg下降缓慢，尽管14%的患者可能发生低水平或qHBsAg下降更快。第3年qHBsAg降低>0.3 log IU/mL可识别出更有可能达到低水平和HBsAg血清清除的患者。
HBeAg-negative chronic hepatitis B patients require long-term nucleos(t)ide analogues(NAs) because loss of surface antigen (HBsAg) is unusual. Low quantitative HBsAg (qHBsAg) levels can identify patients with higher probability of seroclearance. The aim of our study was to evaluate qHBsAg in HBeAg-negative patients receiving NAs to predict a reduction of HBsAg levels and seroclearance. Retrospective analysis of qHBsAg in HBeAg-negative patients before and at years 1, 3, 5, 8 and over of NAs treatment. From 1999 to 2015, HBsAg was quantified in 358 serum samples from 95 HBeAg-negative patients. Low qHBsAg (<120 IU/mL) was identified at baseline or during follow-up in 14% of patients and HBsAg loss in 4%. No baseline variables predicted seroclearance and only treatment duration predicted low qHBsAg. The annual decline of qHBsAg was -0.102 log IU/mL and the median time to HBsAg loss was 6.04 years. The decline was greater in patients achieving low HBsAg levels (-0.257) than in those who did not (-0.057)(p<0.001). The diagnostic accuracy (ROC curve, 95%CI) of qHBsAg delta at year 3 was 0.89 (0.81–0.97), with cut-off >0.3 log IU/mL showing a positive and negative predictive value of 42% and 100% to identify patients achieving low levels of HBsAg. Reduction of qHBsAg is slow in HBeAg-negative patients receiving NAs, although low levels or faster qHBsAg decline may occur in 14%. A qHBsAg reduction >0.3 log IU/mL at year 3 can identify patients with a higher probability of achieving low levels and HBsAg seroclearance.
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