Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Digestion. 2011;84 Suppl 1:29-34. doi: 10.1159/000334076. Epub 2011 Dec 2.
Since active replication of hepatitis B virus is strongly associated with the development of cirrhosis, hepatocellular carcinoma, and liver-related mortality, antiviral therapy is aimed at maximal viral suppression. However, as no antiviral therapy is perfect due to the emergence of resistant strains and suboptimal efficacy in some patients, modifying the treatment strategies for certain patients in advance is important through prediction of treatment responses. Recently, along with serial monitoring of hepatitis B virus DNA level, quantitative analysis of the serologic markers HBsAg (qHBsAg) and HBeAg (qHBeAg) has been used to predict responses to antiviral therapy. The clinical usefulness of both pretreatment qHBsAg and decline in qHBsAg during treatment was assessed in patients treated with pegylated interferon, suggesting that they might be used as another criterion to identify good and poor responders. Similarly, in patients treated with oral nucleos(t)ide analogues (NAs), the clinical significance of qHBsAg has been reported in some studies. However, as the decline in qHBsAg is much slower during NA therapy and the data on the use of qHBsAg to predict response to NA treatment are very preliminary, its wide application remains to be determined. Another serologic marker (qHBeAg) measured at baseline and during treatment might be applied for identifying good or poor responders to antiviral therapy. Unfortunately, measurement of qHBeAg has not been widely used because it is expensive, nonstandardized, and unavailable in patients with HBeAg-negative chronic hepatitis B (CHB). In conclusion, serologic markers may be potential predictors of response to antiviral therapy in CHB, allowing delivery of the most appropriate treatments to the most suitable patients. Further investigations into the universal clinical usefulness of such markers are needed.
由于乙型肝炎病毒的活跃复制与肝硬化、肝细胞癌和肝脏相关死亡率密切相关，抗病毒治疗旨在实现最大程度的病毒抑制。然而，由于耐药株的出现和某些患者疗效不佳，没有一种抗病毒疗法是完美的，因此通过预测治疗反应，提前为某些患者修改治疗策略非常重要。最近，随着乙型肝炎病毒 DNA 水平的连续监测，乙型肝炎表面抗原（qHBsAg）和乙型肝炎 e 抗原（qHBeAg）的定量分析已被用于预测抗病毒治疗的反应。在接受聚乙二醇干扰素治疗的患者中，评估了治疗前 qHBsAg 和治疗期间 qHBsAg 下降对预测治疗反应的临床意义，提示其可能作为另一个标准来识别良好和不良应答者。同样，在接受口服核苷（酸）类似物（NAs）治疗的患者中，一些研究报告了 qHBsAg 的临床意义。然而，由于 NAs 治疗期间 qHBsAg 的下降速度较慢，并且关于使用 qHBsAg 预测 NAs 治疗反应的数据还很初步，因此其广泛应用仍有待确定。另一个在基线和治疗期间测量的血清学标志物（qHBeAg）也可用于识别抗病毒治疗的良好或不良应答者。不幸的是，由于 qHBeAg 测量昂贵、非标准化且在 HBeAg 阴性慢性乙型肝炎（CHB）患者中不可用，因此尚未广泛应用。总之，血清学标志物可能是 CHB 抗病毒治疗反应的潜在预测指标，可以为最合适的患者提供最合适的治疗。需要进一步研究这些标志物的普遍临床意义。
