乙型肝炎核心相关抗原在预测肝移植后乙型肝炎病毒复发中的作用。
The role of hepatitis B core-related antigen in predicting hepatitis B virus recurrence after liver transplantation.
机构信息
State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, China.
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou City, China.
出版信息
Aliment Pharmacol Ther. 2019 Nov;50(9):1025-1036. doi: 10.1111/apt.15429. Epub 2019 Jul 24.
BACKGROUND
Hepatitis B core-related antigen (HBcrAg) is a viral marker for the development of cirrhosis and hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). However, the relationship between HBcrAg and HBV recurrence after liver transplantation (LT) is unclear.
AIM
To investigate the correlation of serum HBcrAg level with HBV recurrence post-LT to evaluate the prognostic role of the pre-LT HBcrAg level.
METHODS
This retrospective cohort study enrolled 357 CHB patients who received LT for a median of 36.6 months. Univariate and multivariate analyses and time-dependent receiver operating characteristic (ROC) curves for markers associated with HBV recurrence were analysed.
RESULTS
48 patients (13.4%) had HBV recurrence after LT. HBcrAg, detectable HBV DNA, HCC and HCC recurrence were associated with HBV recurrence. In a multivariate analysis, HBcrAg level was independently associated with HBV recurrence, and the relationship between HBcrAg level and incident HBV recurrence was significant and graded (HR: 3.17 per unit; 95% CI: 1.97-5.11; P for trend < .001). Additionally, HBcrAg level was superior to HBV DNA level in predicting HBV recurrence by time-dependent ROC analysis. Patients with an HBcrAg ≥ 5.0 log U/mL had a significantly higher 5-year cumulative recurrence rate than those with an HBcrAg < 5.0 log U/mL (37.6% vs 6%, P < .001); the adjusted hazard ratio was 5.27 (95% CI 2.47-11.25, P < .001).
CONCLUSION
An elevated serum HBcrAg level was independently associated with the risk of HBV recurrence in patients with CHB after LT.
背景
乙型肝炎病毒核心相关抗原（HBcrAg）是慢性乙型肝炎（CHB）患者发生肝硬化和肝细胞癌（HCC）的病毒标志物。然而，HBcrAg 与肝移植（LT）后 HBV 复发之间的关系尚不清楚。
目的
探讨血清 HBcrAg 水平与 LT 后 HBV 复发的相关性，以评估 LT 前 HBcrAg 水平的预后作用。
方法
本回顾性队列研究纳入了 357 例因 CHB 接受 LT 的患者，中位随访时间为 36.6 个月。分析了与 HBV 复发相关的标志物的单因素和多因素分析以及时间依赖性接受者操作特征（ROC）曲线。
结果
48 例（13.4%）患者在 LT 后发生 HBV 复发。HBcrAg、可检测到的 HBV DNA、HCC 和 HCC 复发与 HBV 复发相关。多因素分析显示，HBcrAg 水平与 HBV 复发独立相关，且 HBcrAg 水平与 HBV 复发的关系具有显著性和分级性（HR：每单位 3.17；95%CI：1.97-5.11；P 趋势<0.001）。此外，通过时间依赖性 ROC 分析，HBcrAg 水平在预测 HBV 复发方面优于 HBV DNA 水平。HBcrAg≥5.0 log U/mL 的患者 5 年累积复发率显著高于 HBcrAg<5.0 log U/mL 的患者（37.6%比 6%，P<0.001）；调整后的危险比为 5.27（95%CI 2.47-11.25，P<0.001）。
结论
HBcrAg 水平升高与 LT 后 CHB 患者发生 HBV 复发的风险独立相关。
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