Liu Fen, Zou Feng, Wang Xiwei, Hu Huaidong, Hu Peng, Ren Hong
Department of Infectious Diseases, Second Affiliated Hospital of Chongqing Medical University, Linjiang Road, Yuzhong District, Chongqing, China.
Institute for Viral Hepatitis, Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, Chongqing Medical University, Linjiang Road, Yuzhong District, Chongqing, China.
Virol J. 2015 Nov 2;12:179. doi: 10.1186/s12985-015-0409-y.
BACKGROUND & AIM: The aim was to extract factors from virologic and biochemical profiles at baseline and 24 weeks of treatment to predict HBeAg seroconversion in patients treated with ETV.
HBeAg positive chronic hepatitis B patients receiving ETV naïve-treatment were enrolled. HBV DNA, ALT, and serological markers were prospectively monitored every 6 months for 240 weeks. The cumulative rates of virologic response (VR), biochemical response (BR), and HBeAg seroconversion were determined, and potential predictors for HBeAg seroconversion were identified through uni/multivariate analysis.
Two hundred twenty nine patients were eligible for this study. The cumulative rates of VR, BR, and HBeAg seroconversion at 240 weeks were 88.4 %, 100 %, and 36.7 %, respectively. Multivariate analysis showed that HBV DNA (OR, 2.8, p = 0.003), ALT (OR, 2.6, p = 0.005) at baseline, undetectable HBV DNA within 24 weeks (OR = 3.2, p < 0.001), and body mass index (BMI) ≥24kg/m(2) (OR = 0.038, p = 0.013) were associated with HBeAg seroconversion. A prediction model for probability of HBeAg seroconversion was constructed. Patients can be classified into high (>40 %), intermediate (20-40 %), or low (≤20 %) groups based on the calculated probability of HBeAg seroconversion. The cumulative rates of HBeAg seroconversion were different among the three groups (p < 0.001). About 58 % patients in the high probability group achieved HBeAg seroconversion while almost 90 % patients within the low group remained HBeAg positive.
A combination of HBV DNA, ALT and BMI values at baseline, and undetectable HBV DNA level within 24 weeks can predict HBeAg seroconversion. Both viral and metabolic factors likely determine HBeAg status with ETV treatment.
CTR20132358.
本研究旨在从基线及治疗24周时的病毒学和生化指标中提取相关因素，以预测接受恩替卡韦（ETV）治疗患者的HBeAg血清学转换情况。
纳入初治的HBeAg阳性慢性乙型肝炎患者并接受ETV治疗。前瞻性监测患者的HBV DNA、ALT及血清学指标，每6个月监测一次，共240周。确定病毒学应答（VR）、生化应答（BR）及HBeAg血清学转换的累积发生率，并通过单因素/多因素分析确定HBeAg血清学转换的潜在预测因素。
229例患者符合本研究标准。240周时VR、BR及HBeAg血清学转换的累积发生率分别为88.4%、100%和36.7%。多因素分析显示，基线时的HBV DNA（比值比[OR]，2.8，p = 0.003）、ALT（OR，2.6，p = 0.005），24周内HBV DNA检测不到（OR = 3.2，p < 0.001）以及体重指数（BMI）≥24kg/m²（OR = 0.038，p = 0.013）与HBeAg血清学转换相关。构建了HBeAg血清学转换概率的预测模型。根据计算出的HBeAg血清学转换概率，患者可分为高（>40%）、中（20%-40%）或低（≤20%）三组。三组间HBeAg血清学转换的累积发生率不同（p < 0.001）。高概率组中约58%患者实现了HBeAg血清学转换，而低概率组中近90%患者仍为HBeAg阳性。
基线时的HBV DNA、ALT及BMI值，以及24周内HBV DNA检测不到可预测HBeAg血清学转换。病毒学和代谢因素可能共同决定ETV治疗时的HBeAg状态。
CTR20132358
