胸腺五肽联合干扰素治疗慢性湿疹的疗效观察

目的:探讨胸腺五肽联合干扰素治疗慢性湿疹的临床效果及安全性。方法:随机将2009~2012年我科收治的60例慢性湿疹患者分为两组,治疗组30例在给予相应的抗组胺药、非特异性抗过敏治疗的基础上加用胸腺五肽针10 mg与干扰素α-2b 200万U交替肌注,对照组30例只给予抗组胺药、非特异性抗过敏治疗,两组均在3周后观察其治疗效果及不良反应的发生情况。结果:治疗三周后,治疗组总有效率为70%,对照组总有效率为33.33%,两组总有效率比较差异有统计学意义(P0.05)。两组不良反应的发生率比较并无统计学差异(P0.05)。结论:胸腺五肽联合干扰素治疗慢性湿疹的临床疗效显著,副作用较小,安全性较高,值得临床推广应用。     

替诺福韦联合聚乙二醇干扰素α-2b注射液对慢性乙型肝炎患者HBe Ag血清学转换率和阴转率的影响

摘要 目的：探讨替诺福韦联合聚乙二醇干扰素α-2b注射液对慢性乙型肝炎患者HBe Ag血清学转换率和阴转率的影响。方法：2018年2月到2020年8月选择在我院联合汀州医院诊治的慢性乙型肝炎患者104例,根据随机数字表法把患者分为联合组与对照组各52例。对照组给予聚乙二醇干扰素α-2b注射液治疗,联合组给予替诺福韦联合聚乙二醇干扰素α-2b注射液治疗,两组都治疗观察48 w。对比两组治疗前后患者的HBeAg血清学转换情况及HBV-DNA的转阴情况,血清谷丙转氨酶(Alanine transaminase,ALT)、谷草转氨酶(Aspartate transaminase,AST)含量。结果：治疗后联合组的HBe Ag血清学转换率为11.54 %,高于对照组的3.85 %(P>0.05)。治疗后联合组的HBV DNA 转阴率为100 %,高于对照组的71.17 %(P<0.05)。两组治疗后的血清ALT与AST值低于治疗前(P<0.05),联合组低于对照组(P<0.05)。结论：替诺福韦联合聚乙二醇干扰素α-2b注射液对慢性乙型肝炎患者能提高HBe Ag血清学转换率和阴转率,改善患者的肝功能。     

慢性乙型肝炎病毒感染者HBeAg血清学自然转换及其影响因素分析

目的了解慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者乙型肝炎e抗原(hepatitis Be antigen,HBe Ag)血清学自然转换及其影响因素。方法以寿光市2012年3个强化干预镇街道农村居民乙型病毒性肝炎(简称乙肝)专项调查确诊的HBe Ag阳性感染者的血清学检测结果为基线,与2015年随访的血清学检测结果对比分析。用ELISA检测乙肝血清标志物,用实时荧光定量PCR检测HBV DNA载量,采用速率法检测丙氨酸氨基转移酶(alanine aminotransferase,ALT)。结果 HBe Ag阳性者340例,随访3年,HBe Ag转阴142例,年转阴率13.92%;抗-HBe转换92例,年转换率9.02%。HBe Ag转阴/转换率与HBV DNA载量负相关(r=-0.227,P0.001;r=-0.193,P0.001);HBe Ag转阴/转换率与年龄有关,6~20岁组转阴/转换率低,随年龄增长HBe Ag转阴/转换率增高,各年龄组差异均有统计学意义(χ2=22.74,P0.01;χ2=30.34,P0.01);性别不是HBe Ag转换率的主要影响因素(P0.05)。血清学转换后,HBV DNA载量、ALT水平均较转换前有明显的下降,但仍有一定比例的感染者检出高拷贝的HBV DNA载量。结论 HBV感染过程中存在着HBe Ag血清学自然转换,年龄是HBV DNA载量的主要影响因素,HBe Ag与HBV DNA载量的变化并不完全一致。     

减毒HAV在体外抑制HBV表达HBeAg和HBsAg的实验研究

目的　探索减毒甲型肝炎病毒( HAV) ( H2减毒株)在Hep G2 .2 .15细胞中对乙型肝炎病毒( HBV)表达HBs Ag和HBe Ag的影响。方法　在Hep G2 .2 .15细胞中,加入含3×10 - 2 ( 3×10 4 .5CCID50 / ml) ,3×10 - 3( 3×10 3.5CCID50 / ml)浓度的减毒HAV。按不同疫苗浓度,每4 d换液1次,留取第12和第16天的培养上清液;同时设立对照组。用微粒子酶免分析法检测培养上清液中的HBs Ag和HBe Ag含量。计算减毒HAV在不同浓度,以及不同作用时间长度的条件下,对Hep G2 .2 .15细胞表达HBs Ag和HBe Ag的影响。结果　3×10 - 2 Ampoule/ ml的减毒HAV作用Hep G2 .2 .5细胞12 d后,培养上清液的HBe Ag浓度为( 4 7.2 3±6 .18) S/ CO,低于对照组的( 10 1.15±15 .77) S/ CO,2组比较差异有非常显著性( P<0 .0 1) ;16 d后,上清液HBe Ag含量为( 4 0 .2 7±13.30 ) S/ CO,也显著低于对照组的( 6 5 .85±3.4 6 ) S/ CO( P<0 .0 5 ) ;HBs Ag含量为( 2 .6 8±0 .31) S/ N,低于对照组的( 5 .10±1.2 7)S/ N,差异有显著性( P<0 .0 5 )。而3×10 - 3Ampoule/ ml的减毒HAV作用Hep G2 .2 .15细胞12 d后,培养上清液的HBs Ag浓度与对照组比较有显著性下降( P<0 .0 5 )。结论　一定浓度的减毒HAV可能有直接抑制HBV表达HBs Ag,HBe Ag的作用     

胸腺五肽联合干扰素治疗慢性湿疹的疗效观察

目的：探讨胸腺五肽联合干扰素治疗慢性湿疹的临床效果及安全性。方法：随机将2009-2012年我科收治的60例慢性湿疹患者分为两组,治疗组30例在给予相应的抗组胺药、非特异性抗过敏治疗的基础上加用胸腺五肽针10mg与干扰素α-2b200万u交替肌注,对照组30例只给予抗组胺药、非特异性抗过敏治疗,两组均在3周后观察其治疗效果及不良反应的发生情况。结果：治疗三周后,治疗组总有效率为70％,对照组总有效率为33．33％,两组总有效率比较差异有统计学意义（P〈0．05）。两组不良反应的发生率比较并无统计学差异（P〉0．05）。结论：胸腺五肽联合干扰素治疗慢性湿疹的临床疗效显著,副作用较小,安全性较高,值得临床推广应用。     

乙型肝炎病毒感染Babl/c乳鼠动物模型的研究

目的:目前HBV感染动物模型各有局限,无法全面研究HBV。拟建立人HBV血清感染Babl/c乳鼠的动物模型,以便于研究HBV感染与乳鼠免疫力低下的相关性。方法:将20只Babl/c乳鼠随机分为实验组、对照组、PBS组及空白组,通过高压水动力尾静脉注射法将人HBV血清、正常人血清、PBS注入各组乳鼠体内,记录接种后乳鼠体温及体质量。于接种后第7、15、30 d采集血清标本,应用ELISA检测HBs Ag、HBe Ag的表达情况,实时荧光定量PCR检测HBV DNA浓度。结果:接种后各组小鼠体温及体质量均无明显变化。实验组中共4只乳鼠可检测到HBs Ag为阳性且维持时间长达30 d,但HBe Ag均为阴性,HBV DNA浓度均未达500 IU/ml;余下各组检测HBs Ag、HBe Ag均为阴性。结论:通过高压水动力尾静脉注射法接种人HBV血清,可成功使Babl/c乳鼠感染HBV。本实验证实乳鼠免疫力低下,HBV血清进入体内未能有效清除,对HBV存在易感性,为建立HBV感染动物模型提供实验依据,可用于研究HBV对免疫状态的影响。     

实时定量RT-PCR对乙型肝炎病毒全长RNA(fRNA)的定量检测

目的:建立一种简便的定量检测慢性乙型肝炎患者血清中终止于聚腺苷酸化位点的乙型肝炎病毒全长RNA(f RNA)的方法。方法:选取53例未治疗的乙型肝炎患者及22例HBs Ag阴性的健康者为研究对象,使用锚定oligo-d T的引物对其血清中f RNA进行实时定量反转录PCR检测,统计分析其与HBV DNA、HBcr Ag和HBe Ag的相关性。结果:对f RNA进行实时荧光定量RT-PCR检测的下线为2.3 log copies/ml,标准曲线的相关系数为0.99(P0.0001)。53例乙型肝炎患者中,29例(54.7%)可以检测到f RNA,22例正常对照中没有检测到f RNA。27例HBe Ag阳性和/或高水平HBV DNA的患者全部检测到f RNA,26例HBe Ag阴性并且低水平HBV DNA的乙型肝炎患者中有2例(7.7%)检测到f RNA(P0.0001)。HBe Ag阳性患者血清中f RNA水平高于HBe Ag阴性患者(5.0±0.3 vs.2.9±0.4 log copies/ml,P0.001)。f RNA与HBV DNA/HBcr Ag具有显著相关性(r=0.905、0.881,P0.0001)。Hayashi's定量分析法I显示f RNA与HBV DNA相关性强于其与HBcr Ag的相关性。结论:与HBV DNA和HBe Ag一样,f RNA可作为常规检测判断HBV的复制水平并指导用药。     

泛素特异性蛋白酶18抑制IFNα抗HBV活性但并不抑制IFNλ抗HBV的活性（英文）

干扰素α(IFN-α)是临床最常用的抗乙型肝炎病毒(HBV)药物之一。泛素特异性蛋白酶18(USP18)被证实是抑制IFN-α抗HBV活性的因子,但USP18是否对干扰素λ(IFN-λ)抗HBV有影响还尚未可知。为了明确USP18对IFNλ抗HBV活性的影响,本研究以Hep G2. 2. 15细胞作为乙肝体外模型,采用脂质体转染法分别向细胞转染p EGFP-USP18、PEGFP-N1经48 h,再经IFN-α和IFN-λ处理24 h,分为阴性对照组﹑USP18过表达+IFN-α组﹑空载组+IFN-α组﹑USP18过表达+IFN-λ组﹑空载组+IFN-λ组。采用Western印迹、RT-q PCR和ELISA检测各组的乙肝病毒标志物、STAT1/p STAT1和下游的干扰素刺激基因(ISGs)的表达。结果显示,与阴性对照组和空载组相比,USP18蛋白在过表达组明显升高(P 0. 05),过表达细胞模型构建成功;在IFN-α处理的两组中,空载组中HBs Ag、HBe Ag、HBc Ag及HBV-DNA的表达均低于USP18过表达组,差异有统计学意义(P 0. 05)。而IFN-λ处理组中,乙肝病毒标志物的差异不明显。在IFN-α处理组中,空载组的ISG15、Mx A、IFIT1和p STAT1表达均高于USP18过表达组,差异有统计学意义(P 0. 05),而在IFN-λ处理组中ISGs和p STAT1的表达无明显差异。上述结果证实,USP18可通过抑制JAK/STAT信号通路的激活来减弱IFN-α抗HBV的活性。研究还证实,IFN-λ可发挥抗HBV的作用,USP18不通过JAK/STAT信号通路抑制其抗HBV活性。     

乳腺癌患者化疗后乙肝病毒再激活及拉米夫定预防性应用的临床研究

目的:探讨化疗引起的乳腺癌患者肝功能损害与乙肝病毒(HBV)感染的相关性及抗病毒治疗在预防化疗引起的HBV再激活中的作用。方法:2006年3月-2010年10月在武汉市第三医院接受化疗的病理确诊为乳腺癌患者(包括术后辅助化疗)为研究对象,比较HBs Ag阴性138例和HBs Ag阳性50例患者化疗后肝功能损害的发生情况,并分析在HBs Ag阳性患者中,预防性使用(21例)与未预防性使用(27例)抗病毒药物拉米夫定后乙肝病毒再激活率的差异。结果:化疗后出现肝功能损害的乳腺癌患者中,HBs Ag阳性患者(31.25%)与HBs Ag阴性患者(16.67%)所占比例的差异有统计学意义(P<0.001)。化疗前预防性使用拉米夫定(4.62%)与未预防性使用(25.93%)拉米夫定,患者出现HBV再激活率的差异亦有统计学意义(P<0.01)。结论:乳腺癌患者化疗后,HBs Ag阳性患者较HBs Ag阴性患者更易出现肝功能损害,预防性使用核苷类似物抗病毒药物拉米夫定,可明显降低乳腺癌合并乙肝患者化疗后HBV再激活肝炎的发生。     

免疫共刺激分子OX40L对乙型肝炎核酸疫苗的免疫佐剂作用

[目的]为了进一步增强HBV DNA疫苗的免疫反应,本研究将共刺激分子OX40L 作为HBV DNA疫苗的分子佐剂免疫小鼠,旨在探讨共刺激分子OX40L对HBV DNA疫苗诱导体液和细胞免疫应答的影响.[方法]我们将HBV DNA疫苗(pcDS2)单独或联合共刺激分子质粒pOX40L免疫C57BL/6小鼠;分别在第0,2,4周进行免疫,在第6周检测抗-HBs IgG、IgG1和IgG2a,T淋巴细胞增殖指数,细胞因子表达水平和体内细胞毒性T淋巴细胞杀伤作用(CTL)等免疫学指标.[结果]pceDS2联合pOX40L免疫组小鼠的抗-HBs水平显著提高,抗-HBs IgG亚类以IgG2a占优;免疫小鼠的T淋巴细胞体外经乙型肝炎表面抗原(HBsAg)刺激后,联合免疫组刺激指数(SI)明显高于pcDS2组;联合免疫组CD4 + T淋巴细胞的IL-4和IFN-γ表达水平及CD8 + T淋巴细胞的IFN-γ表达水平显著升高;DNA疫苗免疫的各组小鼠,HBsAg特异性体内CTL高于对照组,其中联合免疫组小鼠的体内CTL杀伤作用最强.[结论]共刺激分子OX40L不仅能增强HBV DNA疫苗诱导特异性体液免疫应答,还能增强特异性细胞免疫反应,尤其增强体内CTL的杀伤活性,为HBV DNA疫苗的研究奠定了基础.     

基线HBsAg和ALT水平是替比夫定治疗HBeAg阳性慢性乙型肝炎患者e抗原血清学转换的重要预测因素

目的评价初治、单药使用替比夫定治疗HBeAg阳性的慢性乙型肝炎（CHB）患者48周的e抗原血清学转换的基线预测因素。方法97例HBeAg阳性CHB患者分别以基线HBsAg、ALT和HBVDNA水平高低分组,对比两组治疗48周时生化学、病毒学和血清学应答情况。结果基线HBsAg-101500IU／mL组e抗原阴转率和血清学转换率均为42．3％,基线HBsAg〉1500IU／mL组分别为20％和17．8％,两组比较差异均有统计学意义（P〈0．05）;基线ALT〉5ULN组e抗原阴转率和血清学转换率均为45．1％,基线ALT05ULN组分别17．4％和15．2％,两组比较差异均有统计学意义（P〈0．01）;基线HBVDNA〈8．0log-10copies／mL组和基线HBVDNA≥8．0log-10copies／mL组e抗原阴转率和血清学转换率相比,差异无统计学意义（P〉0．05）;基线水平HBsAg≤1500IU／mL且ALT〉5ULN的CHB患者共40例作为观察组,其余57例患者作为对照组,治疗48周时观察组e抗原阴转率和血清学转换率均为45％,对照组分别为22．8％和21．1％,两组比较差异均有统计学意义（P〈0．05）。结论基线HBsAg水平≤1500IU／mL和ALT水平〉5ULN的HBeAg阳性慢性乙型肝炎患者,在接受替比夫定治疗48周时,有较高的e抗原转阴率和血清学转换率;基线HBsAg和ALT水平是替比夫定治疗e抗原血清学转换的重要预测因素。     

Pegylated-Interferon Alpha Therapy for Treatment-Experienced Chronic Hepatitis B Patients

Background

Studies are limited on pegylated interferon (Peg-IFN) therapy for chronic hepatitis B (CHB) patients who failed or relapsed on previous antiviral therapy.

Objectives

We aimed to investigate the effect of Peg-IFN therapy in treatment-experienced CHB patients.

Study Design

A total of 57 treatment-experienced CHB patients at two medical centers were enrolled. All of the patients were treated with Peg-IFN α-2a at 180 μg weekly for 24 or 48 weeks. The hepatitis B serological markers and viral loads were tested every 3 months until 1 year after stopping Peg-IFN therapy. The endpoints were HBV DNA <2000IU/mL, hepatitis B e antigen (HBeAg) seroconversion, and a hepatitis B surface antigen (HBsAg) loss at 12 months post-treatment.

Results

In HBeAg-positive patients, 25.0%, 29.2%, and 12.5% of the patients achieved HBeAg seroconversion, HBV DNA <2000 IU/mL and a combined response, respectively, at 12 months post-treatment. Prior IFN therapy, a high baseline ALT level, a low creatinine level, undetectable HBV DNA at 12 weeks and a decline in HBV DNA >2 log₁₀ IU/mL at 12 weeks of therapy were factors associated with treatment response. In HBeAg-negative patients, 9.1%, 15.2%, and 6.1% of the patients achieved undetectable HBV DNA, HBV DNA <2000 IU/mL, and an HBsAg loss, respectively, at 12 months post-treatment. No factor was significantly associated with the treatment response in the HBeAg-negative patients. The median HBsAg level declined from 3.4 to 2.6 log₁₀ IU/mL in all the patients, and the 5-year cumulative rate of the HBsAg loss was 9.8% in the HBeAg-negative patients. Overall, none of the patients prematurely discontinued the Peg-IFN therapy.

Conclusions

Peg-IFN re-treatment is effective for a proportion of HBeAg-positive treatment-experienced patients; it has limited efficacy for HBeAg-negative treatment-experienced patients. Peg-IFN might facilitate HBsAg loss in HBeAg-negative treatment-experienced patients.     

抗原抗体复合物型治疗性疫苗(乙克)临床研究中患者血清乙型肝炎病毒表面抗原下降的分析与启示

近年来全球慢性乙型肝炎(chronic hepatitis B,CHB)防治指南提出了“功能性治愈”(functional cure)的概念,即患者经过治疗达到血清乙型肝炎病毒表面抗原(hepatitis B virus surface antigen,HBsAg)消失,但现有抗病毒治疗很难实现这一目标。本研究对既往临床试验中经抗原抗体复合物型治疗性疫苗(乙克)治疗后的CHB患者HBsAg下降情况进行了归纳分析,结果显示,经乙克治疗随访后达到乙型肝炎e抗原(hepatitis B e antigen,HBeAg)血清学转换者的HBsAg下降高达0.95log₁₀IU/mL,显著高于未达到HBeAg血清学转换者的0.32log₁₀IU/mL(P<0.01),而经氢氧化铝佐剂治疗随访后发生HBeAg血清学转换(0.49log₁₀IU/mL)者与未发生HBeAg血清学转换者(0.36log₁₀IU/mL)之间HBsAg下降无统计学差异。乙克组治疗过程中,丙氨酸氨基转移酶(alanine aminotransferase,ALT)骤升(ALT flare)在HBsAg下降>1.0log₁₀IU/mL者中较多见,氢氧化铝组未观察到此现象。回归分析显示,乙克治疗后HBsAg下降的影响因素有患者出现HBeAg血清学转换、感染的HBV为B基因型、治疗过程中ALT出现10倍增高,以及基线血清HBsAg为高水平。结果提示,乙克诱导的特异性免疫对降低CHB患者血清HBsAg水平有一定效果,采用“抗病毒药物治疗＋针对HBsAg的中和性抗体被动免疫＋乙克主动免疫”的“三明治”治疗策略可能会提高“功能性治愈”率。     

Early Serum HBsAg Kinetics as Predictor of HBsAg Loss in Patients with HBeAg-Negative Chronic Hepatitis B after Treatment with Pegylated Interferonα-2a

Hepatitis B surface antigen (HBsAg) loss is an ideal treatment endpoint for patients with chronic hepatitis B (CHB). We investigated the predictive value of on-treatment HBsAg levels for HBsAg loss in hepatitis B e antigen (HBeAg)-negative CHB patients who received 120-week PEG-IFNα-2a treatment. Serum HBV DNA, HBsAg, and anti-HBs levels were assayed at baseline and every 3 months during the treatment. Of 81 patients, 12 achieved HBsAg loss, 20 achieved HBsAg < 100 IU/mL, and 49 maintained HBsAg≥100 IU/mL. HBsAg loss rate was only 3.7% at 48 weeks, while it reached to 11.1% and 14.8% after treatment of 96 weeks and 120 weeks. The cutoff HBsAg levels at 12 weeks predicting HBsAg loss at 96 weeks and 120 weeks of treatment were 400 IU/mL and 750 IU/mL, with AUC 0.725 and 0.722, positive predictive value (PPV) 29.41% and 30.56%, and negative predictive value (NPV) 93.75% and 97.78%, respectively. The cutoff HBsAg levels at 24 weeks predicting HBsAg loss at 96 weeks and 120 weeks of treatment were 174 IU/mL and 236 IU/mL respectively, with AUC 0.925 and 0.922, PPV 40.0% and 46.15%, and both NPV 100%. The predictive ability of the cutoff HBsAg levels at 24 weeks was better than that at 12 weeks for HBsAg loss at either 96 or 120 weeks (χ²=3.880, P=0.049 and χ²=4.412, P=0.036). These results indicate that extended therapy is critical to HBsAg loss in HBeAg-negative CHB patients during PEG-IFN treatment, and the HBsAg level at 24 weeks can be used to predict HBsAg loss during tailoring PEG-IFN therapy.

     

CXCL9 Associated with Sustained Virological Response in Chronic Hepatitis B Patients Receiving Peginterferon Alfa-2a Therapy: A Pilot Study

Background and Aims

There is lack of a practical biomarker to predict sustained virological response (SVR) in chronic hepatitis B (CHB) patients undergoing peginterferon alfa-2a (PEG-IFN). The aim of this pilot study was to identify immunological features associated with SVR.

Methods

Consecutive 74 CHB patients receiving 24 weeks (for hepatitis B e antigen (HBeAg)-positive) or 48 weeks (for HBeAg-negative) PEG-IFN, were prospectively enrolled. Serum HBV viral loads, hepatitis B surface antigen (HBsAg), CXCL9, IFN-γ-inducible protein 10 (IP-10), interferon-gamma (IFN-γ) and transforming growth factor beta (TGF-β) were measured at baseline and week 12. SVR was defined as HBeAg seroconversion combined with viral load <2000 IU/mL in HBeAg-positive (n=36), and viral load <2000 IU/mL in HBeAg-negative patients (n=38) at 48 weeks after the end of treatment.

Results

Nineteen patients (25.7%), 7 in HBeAg-positive and 12 in HBeAg-negative, achieved SVR. There were significant declines of HBV DNA, HBsAg, IP-10 and IFN-γ levels at week 12. In multivariate analysis, pre-treatment CXCL9 >80 pg/mL, HBV DNA <2.5 x 10⁷ IU/mL and on-treatment HBV viral load, HBsAg decline >10% at week 12 were predictors of SVR. The performance of CXCL9 in predicting SVR was good in patients with HBV DNA <2.5 x 10⁷ IU/mL, particularly in HBeAg-negative CHB cases (positive predictive value, PPV= 64.3%).

Conclusions

Pre-treatment CXCL9 level has the potential to select CHB patients who can respond to PEG-IFN, especially in HBeAg-negative patients with low viral loads.     

α-2-HS-glycoprotein is a potential marker predicting hepatitis B e antigen seroconversion in patients with chronic hepatitis B during treatment with pegylated interferon alfa-2b

The efficacy of interferon (IFN) is limited in about 1/3 of patients with chronic hepatitis B (CHB). We used two-dimensional electrophoresis (2-DE)-based proteomic strategies to identify potential serum markers predicting hepatitis B e antigen (HBeAg) seroconversion in these patients during IFN therapy. Two groups of patients were enrolled: training and validation. In the training group, 2-DE experiments and subsequent identification of altered levels of proteins showed that α-2-HS-glycoprotein, leucine-rich α-2-glycoprotein, and haptoglobin were significantly upregulated as compared with baseline levels in the HBeAg seroconversion group, whereas apolipoprotein C-III precursor, leucine-rich α-2-glycoprotein, and α-albumin were downregulated in the non-seroconversion group. For patients with HBeAg seroconversion in the training group, Western blot analyses showed that α-2-HS-glycoprotein levels in 75% of patients were significantly upregulated at the end of the treatment as compared with baseline levels. Subsequent experiments in the validation group showed that α-2-HS-glycoprotein levels were significantly increased at week 4 in 83.33% of patients in the HBeAg seroconversion group. Dynamic changes in the serum level of α-2-HS-glycoprotein may be a potential early marker for predicting HBeAg seroconversion during IFN treatment for CHB.     

Quantitative HBsAg and HBeAg Predict Hepatitis B Seroconversion after Initiation of HAART in HIV-HBV Coinfected Individuals

Objective

Anti-HBe seroconversion and HBsAg loss are important therapeutic endpoints in patients with hepatitis B virus (HBV) infection. Quantitative measures of hepatitis B surface antigen (qHBsAg) and e antigen (qHBeAg) have been identified as potentially useful indicators of therapeutic response in HBV monoinfection. The aim of this study was to examine serological change including quantitative biomarkers in HIV-HBV coinfected patients initiating HBV active antiretroviral therapy (ART).

Methods

HIV-HBV coinfected individuals from Thailand were followed for up to 168 weeks post ART. Rates and associations of qualitative serological change were determined. Longitudinal changes in qHBsAg and qHBeAg were measured and their utility as predictors of response examined.

Results

Forty seven patients were included of whom 27 (57%) were HBeAg positive at baseline. Median CD4 count was 48 cells/mm³. Over a median follow-up of 108 weeks 48% (13/27) lost HBeAg, 12/27 (44%) achieved anti-HBe seroconversion and 13% (6/47) HBsAg loss. Anti-HBe seroconversion was associated with higher baseline ALT (p = 0.034), lower qHBsAg (p = 0.015), lower qHBeAg (p = 0.031) and greater HBV DNA decline to week 24 (p = 0.045). Sensitivity and specificity for qHBsAg and qHBeAg decline of >0.5 log at week 12 and >1.0 log at week 24 were high for both anti-HBe seroconversion and HBsAg loss.

Conclusions

Rates of serological change in these HIV-HBV coinfected individuals with advanced immunodeficiency initiating HBV-active ART were high. Baseline and on treatment factors were identified that were associated with a greater likelihood of subsequent anti-HBe seroconversion, including both quantitative HBsAg and HBeAg, suggesting these biomarkers may have utility in this clinical setting.     

聚乙二醇干扰素a-2a联合拉米夫定治疗HBeAg阳性慢性乙型肝炎疗效观察

目的目的观察聚乙二醇干扰素a-2a联合拉米夫定治疗HBeAg阳性慢性乙型肝炎疗效。方法采用开放、随机、对照临床试验。所选120例患者分为两组：PegIFNa-2a联合拉米夫定组（A组）和单用PegIFNa-2a组（B组）。分别在治疗12周、24周、治疗52周停药及停药后随访26周时进行疗效评价。结果A、B组治疗结束时HBVDNA阴转率分别为86．7％（52／60）、53．3％（32／60）;ALT复常率88．3％（53／60）、60％（36／60）;HBeAg阴转率70％（42／60）、38．3％（23／60）;HBsAg阴转率26．7％（16／60）、11．7％（7／60）;抗-HBs阳转率分别为23．3％（14／60）、8．3％（5／60）;抗-HBeAb阳转率分别为65．0％（39／60）、35．0％（21／60）,差异均具有统计学意义（P〈0．01或P〈0．05）。结论PegIFNa-2a联合拉米夫定治疗HBeAg阳性慢性乙型肝炎的疗效优于单用Peg IFNa-2a     

Negative HBcAg in immunohistochemistry assay of liver biopsy is a predictive factor for the treatment of patients with nucleos(t)ide analogue therapy

The hepatitis B core antigen (HBcAg) is an important target for antiviral response in chronic hepatitis B (CHB) patients. However, the correlation between HBcAg in the hepatocyte nucleus and nucleos(t)ide analogue (NA) therapeutic response is unclear. We sought to evaluate the role of HBcAg by analysing liver biopsies for viral response in NA‐naïve hepatitis B e antigen (HBeAg) positive (+) CHB patients via immunohistochemistry (IHC). A total of 48 HBcAg‐negative (?) patients and 48 HBcAg (+) patients with matching baseline characteristics were retrospectively analysed for up to 288 weeks. Virological response (VR) rates of patients in the HBcAg (?) group were significantly higher at week 48 and 96 than the HBcAg (+) group (77.1% versus 45.8% at week 48, respectively, P = 0.002 and 95.3% versus 83.3% at week 96, respectively, P = 0.045). The serological negative conversion rate of HBeAg was significantly higher in the HBcAg (?) than in the HBcAg (+) group from week 96 to 288 (35.4 % versus 14.6% at week 96, respectively, P = 0.018; 60.4% versus 14.6%, respectively, P < 0.001 at week 144; 72.9% versus 35.4%, respectively, P < 0.001 at week 288). The cumulative frequencies of VR and lack of HBeAg were higher in the HBcAg (?) group (both P < 0.05). Binary logistic regression analysis showed that HBcAg (?) was the predictor for the lack of HBeAg (OR 4.482, 95% CI: 1.58–12.68). In summary, the absence of HBcAg in the hepatocyte nucleus could be an independent predictor for HBeAg seroconversion rates during NA‐naïve treatment in HBeAg (+) CHB patients.     

基线血清外泌体miR-155-5p联合乙型肝炎病毒DNA定量实验预测聚乙二醇干扰素治疗乙型肝炎e抗原阳性慢性乙型肝炎的疗效

探讨聚乙二醇干扰素(peginterferon, Peg-IFN)治疗乙型肝炎e抗原(hepatitis B e antigen, HBeAg)阳性慢性乙型肝炎(chronic hepatitis B, CHB)患者48周后,基线血清外泌体miR-155-5p表达水平联合乙型肝炎病毒DNA定量实验在预测HBeAg血清学转换中的价值。回顾性分析2016年6月至2019年6月在本中心初次接受抗病毒治疗的HBeAg阳性CHB患者88例。根据Peg-IFN治疗48周后是否发生HBeAg血清学转换,将患者分为治疗应答组和无应答组。采用多因素logistic回归探讨预测Peg-IFN治疗应答的因子,并应用受试者工作特征(receiver operating characteristic, ROC)曲线下面积评估预测效能。结果发现基线血清外泌体miR-155-5p(OR＝2.193,95% CI 1.315～3.655,P＝0.003)和HBV DNA(OR＝0.398,95% CI 0.163～0.976,P＝0.036)是Peg-IFN治疗效果的独立预测因子。基线血清外泌体miR-155-5p和HBV DNA的截断值分别取2.3和7.2 log₁₀IU/mL时,相应的ROC曲线下面积分别为0.788(95% CI 0.682～0.893)和0.704(95% CI 0.577～0.824)。基线血清外泌体miR-155-5p表达水平≥2.3且HBV DNA定量≤7.2 log₁₀IU/mL的患者,Peg-IFN治疗48周后其HBeAg血清学转换率最高,为66.67% (10/15);而基线血清外泌体miR-155-5p表达水平<2.3且HBV DNA定量>7.2 log₁₀IU/mL的患者,Peg-IFN 治疗48周后其HBeAg血清学转换率最低,仅为3.03%(1/33)。这些结果表明,基线血清外泌体miR-155-5p表达水平联合HBV DNA定量实验可以作为Peg-IFN 治疗HBeAg阳性CHB疗效的预测因子,对于优化CHB的抗病毒治疗有积极作用。