Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str.1, Hannover, Germany.
J Hepatol. 2010 Apr;52(4):514-22. doi: 10.1016/j.jhep.2010.01.014. Epub 2010 Feb 13.
BACKGROUND & AIMS: The quantifiable level of HBsAg has been suggested as a predictor of treatment response in chronic hepatitis B. However, there is limited information on HBsAg levels considering the dynamic natural course of HBV-infection. This study aimed to determine HBsAg levels in the different phases of HBV-infection in European HBsAg-positive patients.
226 HBV-monoinfected patients, not undergoing antiviral therapy, were analyzed in a cross-sectional study. Patients were categorized according to the phase of HBV-infection: HBeAg(+) immune tolerance phase (IT, n=30), immune clearance phase (IC, n=48), HBeAg(-) low-replicative phase (LR, n=68), HBeAg(-) hepatitis (ENH, n=68), and acute hepatitis B (n=12). HBsAg was quantified and correlated with HBV-DNA, HBV-genotypes and clinical parameters. In addition, 30 LR-patients were followed longitudinally.
HBsAg levels were higher in IT-patients and IC-patients compared to LR-patients and ENH-patients (4.96/4.37/3.09/3.87-log(10)IU/ml, p<0.001). HBsAg showed a strong correlation with HBV-DNA during acute hepatitis B (R=0.79, p<0.01). Correlation of HBsAg and HBV-DNA was weak or missing when analyzing different phases of persistent HBV-infection separately. However, associations between HBsAg and HBV-DNA were observed in patients infected with HBV-genotype D but not with HBV-genotype A. LR-patients with HBV-reactivation during follow-up (increase of HBV-DNA >2000IU/ml) showed >3-fold higher baseline HBsAg levels with a NPV of 95% for an HBsAg cut-off of 3500IU/ml.
HBsAg levels show significant differences during the natural course of HBV-infection and between HBV-genotypes. These findings may have important implications for understanding the natural history of HBV-infection and for using quantitative HBsAg as a diagnostic tool, i.e. as a marker for predicting HBV-reactivation.
HBsAg 的定量水平被认为是慢性乙型肝炎治疗反应的预测指标。然而，考虑到乙型肝炎病毒（HBV）感染的动态自然过程，关于 HBsAg 水平的信息有限。本研究旨在确定欧洲 HBsAg 阳性患者在 HBV 感染不同阶段的 HBsAg 水平。
在一项横断面研究中分析了 226 名未接受抗病毒治疗的 HBV 单感染患者。根据 HBV 感染阶段将患者分为以下几类：HBeAg(+)免疫耐受期（IT，n=30）、免疫清除期（IC，n=48）、HBeAg(-)低复制期（LR，n=68）、HBeAg(-)肝炎（ENH，n=68）和急性乙型肝炎（n=12）。定量检测 HBsAg，并与 HBV-DNA、HBV 基因型和临床参数相关联。此外，对 30 名 LR 患者进行了纵向随访。
与 LR 患者和 ENH 患者相比，IT 患者和 IC 患者的 HBsAg 水平更高（4.96/4.37/3.09/3.87-log(10)IU/ml，p<0.001）。在急性乙型肝炎中，HBsAg 与 HBV-DNA 呈强相关性（R=0.79，p<0.01）。分别分析持续性 HBV 感染的不同阶段时，HBsAg 与 HBV-DNA 的相关性较弱或缺失。然而，在感染 HBV 基因型 D 的患者中观察到 HBsAg 与 HBV-DNA 之间存在关联，但在感染 HBV 基因型 A 的患者中未观察到这种关联。在随访期间 HBV 再激活（HBV-DNA 增加>2000IU/ml）的 LR 患者，HBsAg 基线水平高出 3 倍以上，HBsAg 截断值为 3500IU/ml 时，其阴性预测值为 95%。
HBsAg 水平在 HBV 感染的自然病程中以及在不同的 HBV 基因型之间存在显著差异。这些发现可能对理解 HBV 感染的自然史以及将定量 HBsAg 用作诊断工具（即预测 HBV 再激活的标志物）具有重要意义。
