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HBV RNA作为常规指标指导慢性乙型肝炎治疗决策是否只有几步之遥?

庄辉

引用本文:
Citation:

HBV RNA作为常规指标指导慢性乙型肝炎治疗决策是否只有几步之遥?

DOI: 10.3969/j.issn.1001-5256.2022.02.008
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利益冲突声明:作者声明不存在利益冲突。
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    庄辉, zhuangbmu@126.com

Are there only a few steps away from the prime time for hepatitis B virus RNA as a routine marker to guide decision making in treatment of chronic hepatitis B?

More Information
  • 摘要: 本文根据现有临床证据, 讨论了HBsAg和HBV RNA可否作为常规指标指导慢性乙型肝炎的治疗决策。

     

  • 表  1  HBsAg与HBV RNA作为CHB停药标志物的优缺点比较

    特点 HBsAg HBV RNA
    各国指南 推荐 未推荐
    检测方法标准化 标准化 未标准化
    操作复杂性 相对简便 相对较复杂
    临床验证 多项验证 未经大样本验证
    成本效益 相对较高 相对较低
    下载: 导出CSV
  • [1] AHN SH, PARK YN, PARK JY, et al. Long-term clinical and histological outcomes in patients with spontaneous hepatitis B surface antigen seroclearance[J]. J Hepatol, 2005, 42(2): 188-194. DOI: 10.1016/j.jhep.2004.10.026.
    [2] YIP TC, CHAN HL, WONG VW, et al. Impact of age and gender on risk of hepatocellular carcinoma after hepatitis B surface antigen seroclearance[J]. J Hepatol, 2017, 67(5): 902-908. DOI: 10.1016/j.jhep.2017.06.019.
    [3] KIM GA, LIM YS, AN J, et al. HBsAg seroclearance after nucleoside analogue therapy in patients with chronic hepatitis B: Clinical outcomes and durability[J]. Gut, 2014, 63(8): 1325-1332. DOI: 10.1136/gutjnl-2013-305517.
    [4] YIP TC, WONG GL, CHAN HL, et al. HBsAg seroclearance further reduces hepatocellular carcinoma risk after complete viral suppression with nucleos(t)ide analogues[J]. J Hepatol, 2019, 70(3): 361-370. DOI: 10.1016/j.jhep.2018.10.014.
    [5] TERRAULT NA, LOK A, MCMAHON BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance[J]. Hepatology, 2018, 67(4): 1560-1599. DOI: 10.1002/hep.29800.
    [6] European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[J]. J Hepatol, 2017, 67(2): 370-398. DOI: 10.1016/j.jhep.2017.03.021.
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    中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
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    [10] PODLAHA O, WU G, DOWNIE B, et al. Genomic modeling of hepatitis B virus integration frequency in the human genome[J]. PLoS One, 2019, 14(7): e0220376. DOI: 10.1371/journal.pone.0220376.
    [11] MEIER MA, CALABRESE D, SUSLOV A, et al. Ubiquitous expression of HBsAg from integrated HBV DNA in patients with low viral load[J]. J Hepatol, 2021, 75(4): 840-847. DOI: 10.1016/j.jhep.2021.04.051.
    [12] WANG J, DU M, HUANG H, et al. Reply to: "Serum HBV pgRNA as a clinical marker for cccDNA activity": Consistent loss of serum HBV RNA might predict the "para-functional cure" of chronic hepatitis B[J]. J Hepatol, 2017, 66(2): 462-463. DOI: 10.1016/j.jhep.2016.10.034.
    [13] GIERSCH K, ALLWEISS L, VOLZ T, et al. Serum HBV pgRNA as a clinical marker for cccDNA activity[J]. J Hepatol, 2017, 66(2): 460-462. DOI: 10.1016/j.jhep.2016.09.028.
    [14] LIU S, ZHOU B, VALDES JD, et al. Serum hepatitis B virus RNA: A new potential biomarker for chronic hepatitis B virus infection[J]. Hepatology, 2019, 69(4): 1816-1827. DOI: 10.1002/hep.30325.
    [15] WEHMEYER MH, SCHULZE ZUR WIESCH J. Editorial: Only steps away from prime time? Hepatitis B virus RNA as routine marker to guide HBV treatment decisions[J]. Aliment Pharmacol Ther, 2021, 54(7): 970-971. DOI: 10.1111/apt.16560.
    [16] XIA M, CHI H, JANSSEN H, et al. Editorial: Only steps away from primetime? Hepatitis B virus RNA as a routine marker to guide HBV treatment decisions-authors' reply[J]. Aliment Pharmacol Ther, 2021, 54(7): 972-973. DOI: 10.1111/apt.16570.
    [17] KIM MA, KIM SU, SINN DH, et al. Discontinuation of nucleos(t)ide analogues is not associated with a higher risk of HBsAg seroreversion after antiviral-induced HBsAg seroclearance: A nationwide multicentre study[J]. Gut, 2020, 69(12): 2214-2222. DOI: 10.1136/gutjnl-2019-320015.
    [18] CHI H, WONG D, PENG J, et al. Durability of response after hepatitis B surface antigen seroclearance during nucleos(t)ide analogue treatment in a multiethnic cohort of chronic hepatitis B patients: Results after treatment cessation[J]. Clin Infect Dis, 2017, 65(4): 680-683. DOI: 10.1093/cid/cix353.
    [19] ALAWAD AS, AUH S, SUAREZ D, et al. Durability of spontaneous and treatment-related loss of hepatitis B s antigen[J]. Clin Gastroenterol Hepatol, 2020, 18(3): 700-709. e3. DOI: 10.1016/j.cgh.2019.07.018.
    [20] YIP TC, WONG GL, WONG VW, et al. Durability of hepatitis B surface antigen seroclearance in untreated and nucleos(t)ide analogue-treated patients[J]. J Hepatol, 2018, 68(1): 63-72. DOI: 10.1016/j.jhep.2017.09.018.
    [21] WU Y, LIU Y, LU J, et al. Durability of interferon-induced hepatitis B surface antigen seroclearance[J]. Clin Gastroenterol Hepatol, 2020, 18(2): 514-516. e2. DOI: 10.1016/j.cgh.2019.04.020.
    [22] YIP TC, LOK AS. How do we determine whether a functional cure for HBV infection has been achieved?[J]. Clin Gastroenterol Hepatol, 2020, 18(3): 548-550. DOI: 10.1016/j.cgh.2019.08.033.
    [23] FAN R, ZHOU B, XU M, et al. Association between negative results from tests for HBV DNA and RNA and durability of response after discontinuation of nucles(t)ide analogue therapy[J]. Clin Gastroenterol Hepatol, 2020, 18(3): 719-727. e7. DOI: 10.1016/j.cgh.2019.07.046.
    [24] KAEWDECH A, TANGKIJVANICH P, SRIPONGPUN P, et al. Hepatitis B surface antigen, core-related antigen and HBV RNA: Predicting clinical relapse after NA therapy discontinuation[J]. Liver Int, 2020, 40(12): 2961-2971. DOI: 10.1111/liv.14606.
    [25] SETO WK, LIU KS, MAK LY, et al. Role of serum HBV RNA and hepatitis B surface antigen levels in identifying Asian patients with chronic hepatitis B suitable for entecavir cessation[J]. Gut, 2021, 70(4): 775-783. DOI: 10.1136/gutjnl-2020-321116.
    [26] XIA M, CHI H, WU Y, et al. Serum hepatitis B virus RNA level is associated with biochemical relapse in patients with chronic hepatitis B infection who discontinue nucleos(t)ide analogue treatment[J]. Aliment Pharmacol Ther, 2021, 54(5): 709-714. DOI: 10.1111/apt.16538.
    [27] CORNBERG M, LOK AS, TERRAULT NA, et al. Guidance for design and endpoints of clinical trials in chronic hepatitis B-Report from the 2019 EASL-AASLD HBV Treatment Endpoints Conference[J]. J Hepatol, 2020, 72(3): 539-557. DOI: 10.1016/j.jhep.2019.11.003.
    [28] JANG JW, KIM JS, KIM HS, et al. Persistence of intrahepatic hepatitis B virus DNA integration in patients developing hepatocellular carcinoma after hepatitis B surface antigen seroclearance[J]. Clin Mol Hepatol, 2021, 27(1): 207-218. DOI: 10.3350/cmh.2020.0115.
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出版历程
  • 收稿日期:  2022-01-03
  • 录用日期:  2022-01-10
  • 出版日期:  2022-02-20
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