摘要：乙肝病毒表面抗原水平的动态变化在自发性HBsAg清除中的作用尚不清楚。选取未治疗的203名发生了自发性HBsAg清除HBeAg阴性患者研究其HBsAg和HBV DNA的动态变化，同时选取203名未发生自发性HBsAg清除年龄性别匹配的HBeAg阴性患者作为对照。分别检测自发转换组患者3年前，2年前，1年前及6月前及HBsAg清除时的血清样本，相应时间对应的HBsAg平均滴度为23.5, 3.51, 0.524, 以及 0.146 IU/ mL，在所有的时间点上，清除组患者HBsAg以及HBV DNA平均水平均低于对照组（所有P< 0.001），HBsAg以及HBV DNA平均水平持续下降直至HBsAg清除，尽管对照组HBsAg平均水平也在下降（P= 0.006），但HBV DNA水平没有明显变化（P= 0.414）.血清HBsAg水平以及HBsAg下降的Log值是最好的预测HBsAg清除的指标，工作者曲线下面积分别达到0.833 (95%可信区间 [CI]: 0.792-0.873)和0.803(95%可信区间: 0.755–0.849)。理想的HBsAg清除预测指标分别为血清HBsAg水平<200 IU/ mL(敏感度, 84.2%; 特异度, 73.4%)以及每年下降0.5 log IU/mL(敏感度, 62.8%; 特异度, 88.7%)，如果患者HbsAg不小于200 IU/ mL，每年下降超过0.5 log能够很好预测3年后HBsAg清除（AUROC, 0.867; 95% CI: 0.778-0.956）。结论：总之，血清HBsAg水平<200 IU/ mL和每年下降0.5 log IU/mL可预测患者在此后3年中可发生HBsAg清除，这些参数也许可作为考虑慢性乙型肝炎疗程和停药的良好指标。
A Large Case-Control Study on the Predictability of Hepatitis B Surface Antigen Levels Three Years Before Hepatitis B Surface Antigen Seroclearance
Abstract：
The kinetics of hepatitis B surface antigen (HBsAg) levels preceding spontaneous HBsAg seroclearance has not been fully investigated. The kinetics of HBsAg and hepatitis B virus (HBV) DNA of 203 treatment-naı¨ve, hepatitis B e antigen (HBeAg)-negative patients with spontaneous HBsAg seroclearance were compared with 203 age- and sex-matched HBeAg negative controls. Serum samples at 3 years, 2 years, 1 year, and 6 months before HBsAg
seroclearance and at the time of HBsAg loss were tested. Median HBsAg levels at these respective time points before HBsAg seroclearance were 23.5, 3.51, 0.524, and 0.146 IU/ mL. For all time points, patients with HBsAg seroclearance had significantly lower median HBsAg and HBV DNA levels, compared to those of the controls (all P < 0.001). Median HBsAg and HBV DNA levels declined significantly until HBsAg seroclearance (P < 0.001). Although median HBsAg levels also decreased significantly with time (P = 0.006) in controls, median HBV DNA levels remained similar (P = 0.414). Serum HBsAg levels, followed by HBsAg log reduction, were the best predictors of HBsAg seroclearance, with an area under the receiving operator characteristic (AUROC) of 0.833 (95% confidence interval [CI]: 0.792-0.873) and 0.803 (95% CI: 0.755–0.849), respectively. The optimal cut-off HBsAg level and HBsAg reduction to predict HBsAg seroclearance were <200 IU/ mL (sensitivity, 84.2%; specificity, 73.4%) and 0.5 log IU/mL/year (sensitivity, 62.8%; specificity, 88.7%), respectively. For patients with HBsAg levels³200 IU/mL, an annual 0.5-log reduction was highly predictive of subsequent HBsAg seroclearance (AUROC, 0.867; 95% CI: 0.778-0.956). Conclusion: To conclude, serum HBsAg <200 IU/mL and 0.5-log reduction in HBsAg were predictive of HBsAg seroclearance within 3 years of follow- up. These parameters may serve as good indicators for the consideration of treatment duration and cessation for chronic hepatitis B.
中国人民武装警察部队后勤学院附属医院 肝胆胰脾科 李海 摘译
本文首次发表于[Hepatology, 2012, 56(3):812-819]
本文首次发表于[Hepatology, 2012, 56(3):812-819]
A Large Case-Control Study on the Predictability of Hepatitis B Surface Antigen Levels Three Years Before Hepatitis B Surface Antigen Seroclearance
Abstract：
The kinetics of hepatitis B surface antigen (HBsAg) levels preceding spontaneous HBsAg seroclearance has not been fully investigated. The kinetics of HBsAg and hepatitis B virus (HBV) DNA of 203 treatment-naı¨ve, hepatitis B e antigen (HBeAg)-negative patients with spontaneous HBsAg seroclearance were compared with 203 age- and sex-matched HBeAg negative controls. Serum samples at 3 years, 2 years, 1 year, and 6 months before HBsAg
seroclearance and at the time of HBsAg loss were tested. Median HBsAg levels at these respective time points before HBsAg seroclearance were 23.5, 3.51, 0.524, and 0.146 IU/ mL. For all time points, patients with HBsAg seroclearance had significantly lower median HBsAg and HBV DNA levels, compared to those of the controls (all P < 0.001). Median HBsAg and HBV DNA levels declined significantly until HBsAg seroclearance (P < 0.001). Although median HBsAg levels also decreased significantly with time (P = 0.006) in controls, median HBV DNA levels remained similar (P = 0.414). Serum HBsAg levels, followed by HBsAg log reduction, were the best predictors of HBsAg seroclearance, with an area under the receiving operator characteristic (AUROC) of 0.833 (95% confidence interval [CI]: 0.792-0.873) and 0.803 (95% CI: 0.755–0.849), respectively. The optimal cut-off HBsAg level and HBsAg reduction to predict HBsAg seroclearance were <200 IU/ mL (sensitivity, 84.2%; specificity, 73.4%) and 0.5 log IU/mL/year (sensitivity, 62.8%; specificity, 88.7%), respectively. For patients with HBsAg levels³200 IU/mL, an annual 0.5-log reduction was highly predictive of subsequent HBsAg seroclearance (AUROC, 0.867; 95% CI: 0.778-0.956). Conclusion: To conclude, serum HBsAg <200 IU/mL and 0.5-log reduction in HBsAg were predictive of HBsAg seroclearance within 3 years of follow- up. These parameters may serve as good indicators for the consideration of treatment duration and cessation for chronic hepatitis B.
