Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
Hepatology. 2011 Aug;54(2):E1-9. doi: 10.1002/hep.24473.
This clinically relevant review focuses on recent findings concerning hepatitis B surface antigen (HBsAg) quantitation in untreated patients and treated patients with chronic hepatitis B. Recent studies and emerging data have shown that both HBsAg and hepatitis B virus (HBV) DNA levels decline during the natural course of a chronic HBV infection; they are lowest in the inactive phase, which is also characterized by the highest HBsAg/HBV DNA ratio. It has been demonstrated that the combined use of HBsAg and HBV DNA levels might help in the identification of true inactive carriers with high accuracy. Retrospective analyses of HBsAg levels in patients undergoing therapy have suggested a role for HBsAg quantitation in monitoring the response to therapy. In comparison with nucleos(t)ide analogues (NAs), interferon-based therapy results in greater overall declines in serum HBsAg levels. A rapid on-treatment decline in HBsAg levels appears to be predictive of a sustained response. With the aid of HBsAg quantitation, it appears that we can anticipate an individualized approach to tailoring the treatment duration. The proposal of early stopping rules for patients not responding to pegylated interferon (according to a lack of any HBsAg decline) represents a step toward a response-guided approach. The development of stopping rules for patients treated with NAs is desirable for reducing the need for lifelong therapy. However, before stopping rules for antiviral therapy can be applied, we need to learn more about the kinetics of HBsAg declines during the natural history of the infection and as a response to therapy so that we can better define the best timing, the relevant HBsAg cutoff levels, and the best ways to apply these rules in clinical practice.
这篇临床相关的综述主要关注未经治疗的慢性乙型肝炎患者和经治患者乙型肝炎表面抗原（HBsAg）定量的最新发现。最近的研究和新出现的数据表明，HBsAg 和乙型肝炎病毒（HBV）DNA 水平在慢性 HBV 感染的自然病程中均下降；在非活动期最低，而非活动期的 HBsAg/HBV DNA 比值也最高。已经证明，HBsAg 和 HBV DNA 水平的联合使用可能有助于以高准确度识别真正的非活动型携带者。对接受治疗的患者的 HBsAg 水平进行回顾性分析表明，HBsAg 定量在监测治疗反应方面具有一定作用。与核苷（酸）类似物（NAs）相比，基于干扰素的治疗会导致血清 HBsAg 水平总体更大幅度的下降。治疗过程中 HBsAg 水平的快速下降似乎可以预测持续的反应。借助 HBsAg 定量，似乎可以预期采用个体化方法来调整治疗持续时间。对于未对聚乙二醇干扰素（根据缺乏任何 HBsAg 下降）产生应答的患者提出早期停止规则建议，这代表了朝着应答指导治疗的方法迈出的一步。对于接受 NAs 治疗的患者，制定停止规则对于减少终身治疗的需求是可取的。然而，在可以应用抗病毒治疗的停止规则之前，我们需要更多地了解感染自然史和治疗应答过程中 HBsAg 下降的动力学，以便我们可以更好地定义最佳时机、相关的 HBsAg 截断值以及在临床实践中应用这些规则的最佳方式。
