Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Prince of Wales Hospital, Shatin, Hong Kong.
J Gastroenterol. 2020 Sep;55(9):899-908. doi: 10.1007/s00535-020-01700-z. Epub 2020 Jun 17.
Hepatitis B core-related antigen (HBcrAg) is a novel serum viral marker. Recent studies showed that its level correlates with the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). We aimed to evaluate the accuracy of serum HBsAg and HBcrAg levels at baseline to predict HCC.
1400 CHB patients who received nucleos(t)ide analogues (NA) treatment since December 2005 were included. Their stored serum samples at baseline were retrieved to measure HBsAg and HBcrAg levels. The primary endpoint was the cumulative incidence of HCC.
85 (6.1%) patients developed HCC during a mean (± SD) follow-up duration of 45 ± 20 months. Serum HBcrAg level above 2.9 log10 U/mL at baseline was an independent factor for HCC in hepatitis B e antigen (HBeAg)-negative patients by multivariable analysis (adjusted hazard ratio 2.13, 95% CI 1.10-4.14, P = 0.025). HBcrAg above 2.9 log U/mL stratified the risk of HCC in HBeAg-negative patients with high PAGE-B score (P = 0.024 by Kaplan-Meier analysis), and possibly in cirrhotic patients (P = 0.08). Serum HBsAg level did not show any correlation with the risk of HCC in all patients or any subgroups.
Serum HBcrAg level predicts the risk of HCC accurately in NA-treated HBeAg-negative CHB patients.
乙型肝炎核心相关抗原（HBcrAg）是一种新型血清病毒标志物。最近的研究表明，其水平与慢性乙型肝炎（CHB）患者发生肝细胞癌（HCC）的风险相关。我们旨在评估基线时血清 HBsAg 和 HBcrAg 水平预测 HCC 的准确性。
纳入了自 2005 年 12 月以来接受核苷（酸）类似物（NA）治疗的 1400 例 CHB 患者。检索其基线时的储存血清样本以测量 HBsAg 和 HBcrAg 水平。主要终点是 HCC 的累积发生率。
在平均（±SD）45±20 个月的随访期间，85（6.1%）例患者发生 HCC。多变量分析显示，基线时血清 HBcrAg 水平高于 2.9 log10 U/mL 是 HBeAg 阴性患者发生 HCC 的独立因素（调整后的危险比 2.13，95%CI 1.10-4.14，P=0.025）。HBcrAg 高于 2.9 log U/mL 分层了 HBeAg 阴性患者高 PAGE-B 评分的 HCC 风险（Kaplan-Meier 分析 P=0.024），可能在肝硬化患者中也是如此（P=0.08）。在所有患者或任何亚组中，血清 HBsAg 水平与 HCC 风险均无相关性。
在接受 NA 治疗的 HBeAg 阴性 CHB 患者中，血清 HBcrAg 水平可准确预测 HCC 的风险。
