Development and validation of a model for hepatitis B e antigen seroconversion in entecavir-treated patients with chronic hepatitis B
Development and validation of a model for hepatitis B e antigen seroconversion in entecavir-treated patients with chronic hepatitis B
复制标题
恩替卡韦治疗的慢性乙型肝炎患者乙型肝炎 e 抗原血清转化模型的开发和验证
DOI：
10.1002/jmv.25628
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发表时间：
2019-11-21
影响因子：
12.7
通讯作者：
Chan, Henry L. Y.
中科院分区：
文献类型：
--
作者：
Shen, Sheng;Wong, Grace L. H.;Chan, Henry L. Y.
实现乙型肝炎e抗原（HBeAg）血清转化是慢性乙型肝炎（CHB）抗病毒治疗中一个令人满意的终点。本研究旨在开发和验证一种新的评分系统，以预测恩替卡韦（ETV）治疗期间HBeAg的血清转化。共有526例接受ETV治疗至少1年的hbeag阳性CHB患者被随机分配到训练和验证队列。基线参数包括乙型肝炎病毒DNA、乙型肝炎表面抗原（HBsAg）、乙型肝炎核心抗体（HBcAb）和丙氨酸转氨酶水平。将实现HBeAg血清转化的患者与未实现HBeAg血清转化的患者进行比较。建立了预测ETV治疗期间HBeAg血清转化的预测模型。中位随访2.67年后，训练组和验证组分别有93例（36.0%）和87例（32.5%）患者出现HBeAg血清转化。由年龄、HBsAg和HBcAb量化组成预测评分。在训练组和验证组中，预测评分5年时受试者工作特征曲线下的面积分别为0.70和0.72。通过使用0.28和0.58的双截止值，该模型具有排除或识别HBeAg血清转化患者的高灵敏度和特异性（训练组的灵敏度为90.3%，特异性为90.2%，验证组的灵敏度为92.8%，特异性为84.4%）。开发并验证了一种使用基线临床变量的新型预测评分。该评分准确地估计了CHB患者在接受5年ETV治疗时发生HBeAg血清转化的概率。
Achieving hepatitis B e antigen (HBeAg) seroconversion is a satisfactory endpoint during antiviral treatment for chronic hepatitis B (CHB). This study aimed to develop and validate a novel scoring system to predict HBeAg seroconversion during entecavir (ETV) treatment. A total of 526 patients with HBeAg-positive CHB treated with ETV for at least 1 year were randomly assigned to the training and validation cohorts. Baseline parameters including hepatitis B virus DNA, hepatitis B surface antigen (HBsAg), hepatitis B core antibody (HBcAb), and alanine aminotransferase level were quantified. Patients who achieved HBeAg seroconversion were compared with those without HBeAg seroconversion. A prediction model was established to predict HBeAg seroconversion during ETV treatment. After a median follow up of 2.67 years, 93 (36.0%) and 87 (32.5%) patients in the training and validation cohorts developed HBeAg seroconversion. A prediction score composed of age, HBsAg and HBcAb quantification was derived. Areas under receiver operating characteristic curve at 5 years of this prediction score were 0.70 and 0.72 in the training and validation cohorts. By using the dual cutoff values of 0.28 and 0.58, the model was endowed with high sensitivity and specificity to exclude or identify patients developing HBeAg seroconversion (90.3% sensitivity and 90.2% specificity in the training cohort as well as 92.8% sensitivity and 84.4% specificity in the validation cohort, respectively). A novel prediction score that uses baseline clinical variables was developed and validated. The score accurately estimates the probabilities of developing HBeAg seroconversion at 5-years ETV therapy in patients with CHB.