Longitudinal profiles of highly sensitive hepatitis B surface antigen levels: re-evaluation of HBsAg seroclearance.
Longitudinal profiles of highly sensitive hepatitis B surface antigen levels: re-evaluation of HBsAg seroclearance.
复制标题
高度敏感的乙型肝炎表面抗原水平的纵向特征：HBsAg 血清清除率的重新评估。
DOI：
10.1111/liv.12980
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Yuen MF.
中科院分区：
文献类型：
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作者：
Seto WK;Tanaka Y;Wong DK;Shinkai N;Cheung KS;Liu KS;Fung J;Lai CL;Yuen MF.
背景与目的慢性乙型病毒性肝炎(CHB)表面抗原(HBs)清除后的血清学特征尚未得到很好的研究。方法采用高灵敏度的HBs Ag(hs-HBs Ag)检测方法(检测下限为0.5mIU/ml)，比常规检测方法高出100倍。对按常规方法确定的慢性乙型肝炎患者在清除后0个月、6~12个月和3~5年分别进行血清hs-HBs、HBVDNA和抗-HBs水平的随访。结果109例患者中94例(86.2%)获得3~5年随访，25例(22.9%)接受核苷类药物治疗，平均持续时间为6.0(1.5~12.7)年。0个月、6~12个月和3~5年分别有88例(80.7%)、60例(55.0%)和20例(21.3%)可检出hs-HBs。在3~5岁时，B型患者的抗-HBs阳性率高于C型患者(63.2%和41.1%，P=0.036)。血清抗-HBs阳性与持续的抗-HBs阴性相比，hs-HBs检出率较低(分别为7.4%和40%，P<；0.001)。多因素分析显示，3~5年抗-HBs阴性与hs-HBs持续阳性独立相关(P=0.007，优势比7.1，95%可信区间1.7~2 9.3)。结论血清hs-HBs Ag可在常规方法确定的乙肝表面抗原清除后的相当比例中检出HBs Ag，尤其是在抗-HBs阴性个体中。血清hs-HBs Ag可能有助于将HBs Ag阴性的CHB与既往仅有乙肝病毒暴露史而无携带者状态的人区分开来。
Background & AimsSerologic profiles after hepatitis B surface antigen (HBsAg) seroclearance in chronic hepatitis B (CHB) have not been well‐studied.MethodsWe employed a highly sensitive HBsAg (hs‐HBsAg) assay (lower detection limit 0.5 mIU/ml), 100 times more sensitive than conventional HBsAg measurements. CHB patients achieving HBsAg seroclearance defined by conventional assays were followed up for serum hs‐HBsAg, HBV DNA and antibody to HBsAg (anti‐HBs) levels at 0 months, 6–12 months and 3–5 years after HBsAg seroclearance. Factors associated with hs‐HBsAg detectability were determined.ResultsOne hundred and nine patients were recruited; 94 (86.2%) were followed up to years 3–5; and 25 patients (22.9%) were on nucleoside analogue therapy for a median duration of 6.0 (range 1.5–12.7) years before HBsAg seroclearance. Detectable hs‐HBsAg was noted in 88 (80.7%), 60 (55.0%) and 20 (21.3%) patients at 0 months, 6–12 months and 3–5 years respectively. At years 3–5, genotype B patients, when compared to genotype C patients, had a higher anti‐HBs positive rate (63.2% and 41.1% respectively,P= 0.036). Serum anti‐HBs positivity, when compared to persistent anti‐HBs negativity, was associated with a lower rate of hs‐HBsAg detection (7.4% and 40% respectively,P< 0.001). Multivariate analysis showed anti‐HBs negativity at years 3–5 to be independently associated with persistently positive hs‐HBsAg (P= 0.007, odds ratio 7.1, 95% confidence interval 1.7–29.3).ConclusionSerum hs‐HBsAg could detect HBsAg presence in a substantial proportion of CHB after HBsAg seroclearance defined by conventional assays, especially among anti‐HBs negative individuals. Serum hs‐HBsAg could potentially assist differentiating HBsAg‐negative CHB from individuals with only past HBV exposure without carrier state.