Measurement of hepatitis B virus core-related antigen is valuable for identifying patients who are at low risk of lamivudine resistance
Measurement of hepatitis B virus core-related antigen is valuable for identifying patients who are at low risk of lamivudine resistance
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DOI：
10.1111/j.1478-3231.2005.01200.x
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发表时间：
2006-02-01
影响因子：
6.7
通讯作者：
Kiyosawa, K
中科院分区：
文献类型：
--
作者：
Tanaka, E;Matsumoto, A;Kiyosawa, K
目的：比较乙型肝炎病毒核心相关抗原（HBVcrAg）检测与HBV DNA检测在预测慢性乙型肝炎患者拉米夫定耐药发生方面的临床应用价值。患者：在接受拉米夫定治疗的81例患者中，25例（31%）在中位随访19.3个月期间出现拉米夫定耐药。结果：HBe抗原预处理阳性率、HBVcrAg或HBV DNA预处理水平在拉米夫定耐药和非耐药患者中无显著差异。开始拉米夫定给药后，2 HBVcrAg和HBV DNA水平均下降；然而，HBVcrAg水平的下降明显慢于HBV DNA。在治疗6个月时HBV DNA水平低于2.6 log copy/ml的56例患者中，拉米夫定耐药的发生率明显低于其余25例患者。后者2年内拉米夫定累计耐药率高达70%，而前者仅为28%。治疗6个月时HBVcrAg水平低于4.6 log U/ml的19例患者在随访期间未发生拉米夫定耐药，而其余50%的患者在2年内发生了拉米夫定耐药。结论：这些结果表明，HBV DNA的测量对于识别拉米夫定耐药高风险患者是有价值的，相反，HBVcrAg的测量对于识别拉米夫定耐药低风险患者是有价值的。
Objective: The clinical usefulness of hepatitis B virus core-related antigen (HBVcrAg) assay was compared with that of HBV DNA assay in predicting the occurrence of lamivudine resistance in patients with chronic hepatitis B. Patients: Of a total of 81 patients who were treated with lamivudine, 25 (31%) developed lamivudine resistance during a median follow-up period of 19.3 months. Results: The pretreatment positive rate of HBe antigen, or pretreatment levels of HBVcrAg or HBV DNA did not differ between patients with and without lamivudine resistance. Levels of both 2 HBVcrAg and HBV DNA decreased after the initiation of lamivudine administration; however, the level of HBVcrAg decreased significantly more slowly than that of HBV DNA. The occurrence of lamivudine resistance was significantly less frequent in the 56 patients whose HBV DNA level was less than 2.6 log copy/ml at 6 months of treatment than in the remaining 25 patients. The cumulative rate of lamivudine resistance was as high as 70% within 2 years in the latter group, while it was only 28% in the former group. Lamivudine resistance did not occur during the follow-up period in the 19 patients whose HBVcrAg level was less than 4.6 log U/ml at 6 months of treatment, while it did occur in 50% of the remaining patients within 2 years. Conclusion: These results suggest that measurement of HBV DNA is valuable for identifying patients who are at high risk of developing lamivudine resistance, and that, conversely, measurement of HBVcrAg is valuable for identifying those who are at low risk of lamivudine resistance.