在 HBeAg 阳性孕妇中，HBsAg 定量对血清 HBV DNA 水平的预测价值。
A predictive value of quantitative HBsAg for serum HBV DNA level among HBeAg-positive pregnant women.
机构信息
Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China.
出版信息
Vaccine. 2012 Aug 3;30(36):5335-40. doi: 10.1016/j.vaccine.2012.06.036. Epub 2012 Jun 27.
BACKGROUND
The high maternal HBV DNA level is the most important factor contributing to HBV perinatal transmission. This study is to explore whether HBsAg can be used as a surrogate marker of serum HBV DNA for HBsAg-positive pregnant women.
METHODS
A total of 975 HBsAg-positive pregnant women and their infants were enrolled in this study. All infants received three doses of a yeast-derived recombinant Hepatitis B vaccine at 0, 1 and 6 months. They were also given Hepatitis B immunoglobulin (HBIG) at birth. HBsAg and HBeAg were determined using Abbott Architect assays while serum HBV DNA level was detected by the Abbott Real Time HBV DNA assay.
RESULTS
Of the 975 subjects, 367 (37.6%) were HBeAg-positive and 608 (62.4%) were HBeAg-negative. Among the HBeAg-positive group, the samples with HBV DNA levels of ≥7.0 logIU/mL were 76.6% (281/367), and it was only 0.7% (4/608) for the HBeAg-negative group. HBV DNA level was positively correlated with HBsAg in HBeAg-positive group (r=0.786, p<0.001) but not in HBeAg-negative group (r=0.022, p=0.593). Among HBeAg-positive group, the area under the receiver-operator curve (ROC) of HBsAg titer for high HBV DNA level (≥7.0 logIU/mL) was 0.961 (95% CI, 0.940-0.983, p<0.001). The optimum cut-off point HBsAg titer above 4.1 logIU/mL had a sensitivity of 85.1%, specificity of 96.5%, and accuracy of 87.5% to predict HBV DNA levels of ≥7.0 logIU/mL. Of 367 infants born to mothers with HBeAg-positive, perinatal transmission was detected in 24 infants (6.5%, 24/367). Their mothers all had serum HBV DNA levels of ≥7.0 logIU/mL, 23 (95.8%) had HBsAg titers of ≥4.1 logIU/mL and the other mother had HBsAg titer of 3.9 logIU/mL. Of 608 infants born to mothers with HBeAg-negative, only one (0.2%, 1/608) became HBsAg-positive at the age of 7 months, and the mother of the infant had serum HBV DNA level of 3.4 logIU/mL and HBsAg titer of 1.8 logIU/mL, respectively.
CONCLUSION
Serum HBsAg titer may be used as a surrogate marker of serum HBV DNA for HBeAg-positive pregnant women.
背景
高母体 HBV DNA 水平是导致母婴传播的最重要因素。本研究旨在探讨 HBsAg 是否可作为 HBsAg 阳性孕妇血清 HBV DNA 的替代标志物。
方法
本研究共纳入 975 例 HBsAg 阳性孕妇及其婴儿。所有婴儿在 0、1 和 6 个月时接受三剂酵母衍生的重组乙型肝炎疫苗，并在出生时接受乙型肝炎免疫球蛋白（HBIG）。使用 Abbott Architect 检测 HBsAg 和 HBeAg，使用 Abbott Real Time HBV DNA 检测血清 HBV DNA 水平。
结果
975 例受试者中，367 例（37.6%）为 HBeAg 阳性，608 例（62.4%）为 HBeAg 阴性。在 HBeAg 阳性组中，HBV DNA 水平≥7.0 logIU/mL 的样本占 76.6%（281/367），而 HBeAg 阴性组仅为 0.7%（4/608）。HBV DNA 水平与 HBeAg 阳性组的 HBsAg 呈正相关（r=0.786，p<0.001），但与 HBeAg 阴性组无相关性（r=0.022，p=0.593）。在 HBeAg 阳性组中，HBV DNA 水平≥7.0 logIU/mL 的 HBsAg 滴度的受试者工作特征曲线（ROC）下面积为 0.961（95%CI，0.940-0.983，p<0.001）。HBsAg 滴度>4.1 logIU/mL 的最佳截断值预测 HBV DNA 水平≥7.0 logIU/mL 的灵敏度为 85.1%，特异性为 96.5%，准确性为 87.5%。在 367 例 HBeAg 阳性母亲所生的婴儿中，有 24 例（6.5%，24/367）发生母婴传播。这些母亲的血清 HBV DNA 水平均≥7.0 logIU/mL，23 例（95.8%）HBsAg 滴度≥4.1 logIU/mL，另一位母亲的 HBsAg 滴度为 3.9 logIU/mL。在 608 例 HBeAg 阴性母亲所生的婴儿中，仅有 1 例（0.2%，1/608）在 7 个月时成为 HBsAg 阳性，该婴儿的母亲血清 HBV DNA 水平为 3.4 logIU/mL，HBsAg 滴度为 1.8 logIU/mL。
结论
血清 HBsAg 滴度可作为 HBeAg 阳性孕妇血清 HBV DNA 的替代标志物。
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