慢性乙型肝炎患者接受聚乙二醇干扰素α-2a治疗后乙肝e抗原持续血清学转换的预测模型

Prediction model for sustained hepatitis B e antigen seroconversion to peginterferon alfa-2a in chronic hepatitis B.

作者信息

Zhu Huilan, Wang Changtai, Zhang Yafei, Wei Shaofeng, Li Xu, Zhang Zhenhua

机构信息

Department of Infectious Diseases, the First Affiliated Hospital, Anhui Medical University, Hefei, China.

出版信息

J Gastroenterol Hepatol. 2016 Dec;31(12):1963-1970. doi: 10.1111/jgh.13414.

DOI:10.1111/jgh.13414

PMID:27075693

Abstract

BACKGROUND AND AIM

Clinically applicable models to predict hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) response to peginterferon (PEG-IFN) are scarce. This study aimed to develop simple scoring systems, based on multiple parameters, for predicting sustained HBeAg seroconversion to PEG-IFN.

METHODS

Eighty-five treatment-naïve patients with HBeAg-positive CHB underwent 52-week PEG-IFN treatment and 24-week follow-up. Logistic regression analysis assessed parameters at baseline and weeks 12, 24, and 52 to predict HBeAg seroconversion at week 24 off-treatment. The best three predictors at each time point were included in prediction models of PEG-IFN therapy efficacy.

RESULTS

The three most meaningful predictors were alanine aminotransferase (ALT) > 5 × ULN, HBeAg ≤ 500 S/CO, and antibody to hepatitis B core antigen (anti-HBc) > 10.7 S/CO at baseline; HBeAg ≤ 20 S/CO, anti-HBc > 11.7 S/CO, and HBeAg decline > 1 log S/CO at week 12; ALT > 2 × ULN, HBeAg ≤ 15 S/CO, and anti-HBc > 10.4 S/CO at week 24; HBeAg ≤ 5 S/CO, anti-HBc > 11.1 S/CO, and hepatitis B virus DNA decline > 2 log copies/mL at week 52. Parameters meeting optimal cutoff thresholds were scored 1 or otherwise scored 0. For total scores of 0 versus 3 at baseline and weeks 12, 24, and 52, response rates were 6.3%, 12.5%, 0%, and 0% versus 90.0%, 83.3%, 76.9%, and 86.4%, respectively.

CONCLUSIONS

We successfully established prediction models for PEG-IFN response in HBeAg-positive CHB.

摘要

背景与目的

临床上可用于预测乙肝e抗原（HBeAg）阳性慢性乙型肝炎（CHB）对聚乙二醇干扰素（PEG-IFN）反应的模型较少。本研究旨在基于多个参数开发简单的评分系统，以预测PEG-IFN治疗后HBeAg持续血清学转换情况。

方法

85例未经治疗的HBeAg阳性CHB患者接受了为期52周的PEG-IFN治疗及24周的随访。采用逻辑回归分析评估基线、第12周、第24周和第52周的参数，以预测停药后第24周的HBeAg血清学转换情况。将每个时间点最具预测性的三个指标纳入PEG-IFN治疗疗效预测模型。

结果

三个最有意义的预测指标分别为：基线时丙氨酸氨基转移酶（ALT）>5×ULN、HBeAg≤500 S/CO以及乙肝核心抗体（抗-HBc）>10.7 S/CO；第12周时HBeAg≤20 S/CO、抗-HBc>11.7 S/CO以及HBeAg下降>1 log S/CO；第24周时ALT>2×ULN、HBeAg≤15 S/CO以及抗-HBc>10.4 S/CO；第52周时HBeAg≤5 S/CO、抗-HBc>11.1 S/CO以及乙肝病毒DNA下降>2 log拷贝/mL。符合最佳临界阈值的指标得分为1，否则得分为0。基线、第12周、第24周和第52周总得分0分与3分的患者，其应答率分别为6.3%、12.5%、0%、0%和90.0%、83.3%、76.9%、86.4%。