HBsAg定量在核苷(酸)类似物个体化抗HBV治疗中的应用价值

周友乾; 李翠

doi:10.3969/j.issn.1001-5256.2019.08.038

HBsAg定量在核苷(酸)类似物个体化抗HBV治疗中的应用价值

DOI: 10.3969/j.issn.1001-5256.2019.08.038

周友乾,
李翠

解放军联勤保障部队第九二二医院暨湖南师范大学附属湘南医院感染科

基金项目:

湖南省卫生计生委课题(C2016096)；

详细信息

中图分类号: R512.62
计量
- 文章访问数: 1127
- HTML全文浏览量: 51
- PDF下载量: 382
- 被引次数: 0
出版历程
- 收稿日期: 2019-02-19
- 出版日期: 2019-08-20

Value of HBsAg quantification in individualized anti-HBV treatment with nucleos (t) ide analogues

Department of Infectious Diseases, 922 Hospital of PLA & Xiangnan Hospital Affiliated to Hunan Normal University

Research funding:

摘要

摘要: 核苷(酸)类似物可有效阻止或延缓慢性HBV感染者的疾病进展,但其疗程长且长期用药存在一定的药物副反应及耐药风险。近期研究发现HBsAg定量对慢性乙型肝炎患者的个体化抗病毒治疗有重要意义。就目前HBsAg定量在核苷(酸)类似物抗HBV治疗的指征评判、疗效预测及停药把握等方面的研究进展进行综述,认为HBsAg定量不仅有利于合理选择抗病毒治疗时机,而且有利于在抗病毒治疗开始时、治疗过程中以及考虑停药时预测患者可能疗效。但是对于HBeAg阳性或阴性感染者各病程分期的最佳预测阈值和不同核苷(酸)类似物抗病毒治疗过程中疗效预测的最佳时间点与最佳预测阈值仍值得进一步研究。
- 乙型肝炎病毒 /
- 乙型肝炎表面抗原 /
- 核苷类 /
- 核苷酸类 /
- 治疗学
Abstract: Nucleos (t) ide analogues can effectively prevent or delay disease progression in patients with chronic hepatitis B virus (HBV) infection, but the course of treatment is long and long-term medication may bring the risk of adverse drug reactions and drug resistance. Recent studies have found that HBsAg quantification has an important value in individualized antiviral treatment for patients with chronic hepatitis B. This article reviews the research advances in the value of HBsAg quantification in judgment of indication for antiviral treatment with nucleos (t) ide analogues, prediction of therapeutic outcome, and timing of drug withdrawal, and it is pointed out that HBsAg quantification can help to determine the timing of antiviral treatment and predict the treatment outcome of patients at the beginning of antiviral treatment, during the treatment process, and when drug withdrawal is considered. Further studies are needed to determine the optimal predictive thresholds for different stages of HBeAg-positive or HBeAg-negative patients, as well as the optimal time point and thresholds for predicting treatment outcome during antiviral treatment with different nucleos (t) ide analogues.
- hepatitis B virus /
- hepatitis B surface antigens /
- nucleosides /
- nucleotides /
- therapeutics

HTML全文

参考文献(29)

[1] CHEN S, LI J, WANG D, et al. The hepatitis B epidemic in China should receive more attention[J]. Lancet, 2018, 391 (10130) :1572.

[2] YU R, FAN R, HOU J. Chronic hepatitis B virus infection:Epidemiology, prevention, and treatment in China[J]. Front Med, 2014, 8 (2) :135-144.

[3] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J]. J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[4] HNER ZU, SIEDERDISSEN C, CORNBERG M. The role of HBsAg levels in the current management of chronic HBV infection[J]. Ann Gastroenterol, 2014, 27 (2) :105-112.

[5] ZENG LY, LIAN JS, CHEN JY, et al. Hepatitis B surface antigen levels during natural history of chronic hepatitis B:A Chinese perspective study[J]. World J Gastroenterol, 2014, 20 (27) :9178-9184.

[6] BRUNETTO MR, OLIVERI F, COLOMBATTO P, et al. Hepatitis B surface antigen serum levels help to distinguish active from inactive hepatitis B virus genotype D carriers[J]. Gastroenterology, 2010, 139 (2) :483-490.

[7] LIU J, YANG HI, LEE MH, et al. Serum levels of hepatitis B surface antigen and DNA can predict inactive carriers with low risk of disease progression[J]. Hepatology, 2016, 64 (2) :381-389.

[8] BROUWER WP, CHAN HL, BRUNETTO MR, et al. Repeated measurements of hepatitis B surface antigen identify carriers of inactive HBV during long-term follow-up[J]. Clin Gastroenterol Hepatol, 2016, 14 (10) :1481-1489.

[9] TSENG TC, LIU CJ, YANG HC, et al. Serum hepatitis B surface antigen levels help predict disease progression in patients with low hepatitis B virus loads[J]. Hepatology, 2013, 57 (2) :441-450.

[10] TSENG TC, LIU CJ, YANG HC, et al. High levels of hepatitis B surface antigen increase risk of hepatocellular carcinoma in patients with low HBV load[J]. Gastroenterology, 2012, 142 (5) :1140-1149.

[11] KAO JH. Risk stratification of HBV infection in Asia-Pacific region[J]. Clin Mol Hepatol, 2014, 20 (3) :223-227.

[12] HONG MZ, HUANG WQ, MIN F, et al. Enhanced HBsAg synthesis correlates with increased severity of fibrosis in chronic hepatitis B patients[J]. PLo S One, 2014, 9 (1) :e87344.

[13] LIN TC, CHIU YC, CHIU HC, et al. Clinical utility of hepatitis B surface antigen kinetics in treatment-nave chronic hepatitis B patients during long-term entecavir therapy[J]. World J Gastroenterol, 2018, 24 (6) :725-736.

[14] PENG CY, LAI HC, SU WP, et al. Early hepatitis B surface antigen decline predicts treatment response to entecavir in patients with chronic hepatitis B[J]. Sci Rep, 2017, 7:42879.

[15] LIEM KS, VAN CAMPENHOUT MJH, XIE Q, et al. Low hepatitis B surface antigen and HBV DNA levels predict response to the addition of pegylated interferon to entecavir in hepatitis B e antigen positive chronic hepatitis B[J]. Aliment Pharmacol Ther, 2019, 49 (4) :448-456.

[16] ZHANG XX, LI MR, XI HL, et al. Dynamic characteristics of serum hepatitis B surface antigen in Chinese chronic hepatitis B patients receiving 7 years of entecavir therapy[J]. Chin Med J (Engl) , 2016, 129 (8) :929-935.

[17] MARCELLIN P, BUTI M, KRASTEV Z, et al. Kinetics of hepatitis B surface antigen loss in patients with HBe Ag-positive chronic hepatitis B treated with tenofovir disoproxil fumarate[J]. J Hepatol, 2014, 61 (6) :1228-1237.

[18] WURSTHORN K, JUNG M, RIVA A, et al. Kinetics of hepatitis B surface antigen decline during 3 years of telbivudine treatment in hepatitis B e antigen-positive patients[J]. Hepatology, 2010, 52 (5) :1611-1620.

[19] KIM JH, MOON HW, KO SY, et al. Hepatitis B surface antigen levels at 6 months after treatment can predict the efficacy of lamivudine-adefovir combination therapy in patients with lamivudine-resistant chronic hepatitis B[J]. Clin Mol Hepatol, 2014, 20 (3) :274-282.

[20] GAO Y, LI Y, MENG Q, et al. Serum hepatitis B virus DNA, RNA, and HBs Ag:Which correlated better with intrahepatic covalently closed circular DNA before and after nucleos (t) ide analogue treatment?[J]. J Clin Microbiol, 2017, 55 (10) :2972-2982.

[21] LIANG WY, REN SD, DUN ZN, et al. Clinical observation of a144-week entecavir therapy for HBe Ag-positive chronic HBV carriers with high viral load[J]. Int J Virol, 2017, 24 (3) :187-191. (in Chinese) 梁文燕, 任树冬, 敦志娜, 等.恩替卡韦治疗高病毒载量HBe Ag阳性慢性HBV携带者144周的临床观察[J].国际病毒学杂志, 2017, 24 (3) :187-191.

[22] ZHOU YQ, LI C, YIN FM, et al. Change in HBsAg quantification after HBV DNA negative conversion in chronic hepatitis B patients treated with nucleos (t) ide analogues[J]. J Clin Hepatol, 2019, 35 (5) :977-981. (in Chinese) 周友乾, 李翠, 尹凤鸣, 等.核苷 (酸) 类似物治疗慢性乙型肝炎患者HBV DNA阴转后HBsAg定量的变化[J].临床肝胆病杂志, 2019, 35 (5) :977-981.

[23] CHEVALIEZ S, HZODE C, BAHRAMI S, et al. Long-term hepatitis B surface antigen (HBsAg) kinetics during nucleoside/nucleotide analogue therapy:Finite treatment duration unlikely[J]. J Hepatol, 2013, 58 (4) :676-683.

[24] SETO WK, WONG DK, FUNG J, et al. Reduction of hepatitis B surface antigen levels and hepatitis B surface antigen seroclearance in chronic hepatitis B patients receiving 10 years of nucleoside analogue therapy[J]. Hepatology, 2013, 58 (3) :923-931.

[25] NING Q, HAN M, SUN Y, et al. Switching from entecavir to PegIFN alfa-2a in patients with HBe Ag-positive chronic hepatitis B:A randomised open-label trial (OSST trial) [J]. J Hepatol, 2014, 61 (4) :777-784.

[26] HE LT, YE XG, ZHOU XY, et al. Effect of switching from treatment with nucleos (t) ide analogs to pegylated interferonα-2a on virological and serological responses in chronic hepatitis B patients[J]. World J Gastroenterol, 2016, 22 (46) :10210-10218.

[27] YAN L, ZHU C, LI J, et al. Entecavir add-on or switch-to pegylated interferon improves HBsAg clearance in HBe antigen negative chronic hepatitis B patients[J]. Infect Drug Resist, 2018, 11:2001-2009.

[28] CHEN CH, HSU YC, LU SN, et al. The incidence and predictors of HBV relapse after cessation of tenofovir therapy in chronic hepatitis B patients[J]. J Viral Hepat, 2018, 25 (5) :590-597.

[29] YAO CC, HUNG CH, HU TH, et al. Incidence and predictors of HBV relapse after cessation of nucleoside analogues in HBe Ag-negative patients with HBsAg≤200 IU/m L[J]. Sci Rep, 2017, 7 (1) :1839.

施引文献

资源附件(0)

访问统计