摘要
BACKGROUND Non-invasive evaluation for liver fibrosis is clinically important,especially in patients with undetectable hepatitis B virus(HBV)DNA treated with nucleoside analogs.AIM To clarify the monitoring power of hepatitis B core-related antigen(HBcrAg)for hepatic histologic changes in patients with chronic hepatitis B(CHB)treated with entecavir.METHODS This prospective multicenter study used multiple ordinal and multivariate logistics regression analysis to assess variables associated with Ishak fibrosis score and regression for fibrosis regression,respectively,in 403 CHB patients,including 374 with entecavir for 72 weeks(291 underwent paired liver biopsy)and 29 as controls.RESULTS Level of HBcrAg correlated negatively with liver fibrosis staging(γ=-0.357,P<0.001)in hepatitis B e antigen(HBeAg)-positive patients,and positively with liver fibrosis staging in HBeAg-negative patients.Higher HBcrAg concentration was associated with younger age,HBeAg positive status,high HBV DNA loads,high level of hepatitis B surface antigen(HBsAg)and higher necroinflammation,but not with HBV genotype.Serum concentration of HBcrAg,basal core promoter/precore(BCP/PC)mutant,quantitation of HBsAg(qHBsAg)and platelet counts were independently associated with Ishak fibrosis score on multiple ordinal regression.HBV DNA was undetectable in 88.37%of patients treated with entecavir at week 72,while their level of HBcrAg was still detectable.A greater reduction in post-treatment HBcrAg concentration was associated with the regression of hepatic fibrosis and histological improvement.HBcrAg concentration>6.33 log IU/mL at baseline and logarithmic reduction>1.03 log IU/mL at week 72 were associated with a higher chance of regression of liver fibrosis and histological improvement,respectively.CONCLUSION HBcrAg level is associated with liver fibrosis progression.HBcrAg is an excellent monitor of hepatic histological changes,especially in CHB patients treated with nucleoside analogs.
BACKGROUND Non-invasive evaluation for liver fibrosis is clinically important, especially in patients with undetectable hepatitis B virus(HBV) DNA treated with nucleoside analogs.AIM To clarify the monitoring power of hepatitis B core-related antigen(HBcr Ag) for hepatic histologic changes in patients with chronic hepatitis B(CHB) treated with entecavir.METHODS This prospective multicenter study used multiple ordinal and multivariate logistics regression analysis to assess variables associated with Ishak fibrosis score and regression for fibrosis regression, respectively, in 403 CHB patients,including 374 with entecavir for 72 weeks(291 underwent paired liver biopsy)and 29 as controls.RESULTS Level of HBcr Ag correlated negatively with liver fibrosis staging(γ =-0.357, P <0.001) in hepatitis B e antigen(HBe Ag)-positive patients, and positively with liver fibrosis staging in HBe Ag-negative patients. Higher HBcr Ag concentration was associated with younger age, HBe Ag positive status, high HBV DNA loads, high level of hepatitis B surface antigen(HBs Ag) and higher necroinflammation, but not with HBV genotype. Serum concentration of HBcr Ag, basal core promoter/precore(BCP/PC) mutant, quantitation of HBs Ag(q HBs Ag) and platelet counts were independently associated with Ishak fibrosis score on multiple ordinal regression. HBV DNA was undetectable in 88.37% of patients treated with entecavir at week 72, while their level of HBcr Ag was still detectable.A greater reduction in post-treatment HBcr Ag concentration was associated with the regression of hepatic fibrosis and histological improvement. HBcr Ag concentration > 6.33 log IU/m L at baseline and logarithmic reduction > 1.03 log IU/m L at week 72 were associated with a higher chance of regression of liver fibrosis and histological improvement, respectively.CONCLUSION HBcr Ag level is associated with liver fibrosis progression. HBcr Ag is an excellent monitor of hepatic histological changes, especially in CHB patients treated with nucleoside analogs.
基金
Supported by Chinese Ministry of Science and Technology Grants the Major Science and Technology Special Project Fund Scheme,No.2013ZX10005002
Beijing the Special Clinical Application Research and Translational Grants,No.Z151100004015221
