第23届亚太地区肝脏研究协会年会（APASL 2014）于2014年3月12～15日在澳大利亚布里斯班召开。会上来自韩国亚洲大学医学院的研究人员建议在核苷（酸）类似物（NUCs）治疗的过程中应用前S2抗原水平预测HBsAg和HBeAg的转阴。

研究详情

该研究纳入30位接受NUCs治疗的慢乙肝患者。在治疗过程中，半数病人表面抗原降低到检测线以下。起初30例病人中有22例HBeAg阳性，在治疗的过程中，有14例患者HBeAg转阴，说明病毒复制不再活跃。

所有患者的前S2抗原滴度下降。然而，Seon Joo Ahn博士指出“HBsAg持续存在的患者的前S2抗原水平显著高于HBsAg转阴的患者。在HBsAg转阴的患者中，前S2抗原水平从平均1508 ng/mL 下降到95 ng/mL；在HBsAg未转阴的患者中，前S2抗原水平从平均6024 ng/mL下降到2611 ng/mL。

前S2抗原水平也与基线HBV DNA水平紧密相关。综合考虑，前S2抗原滴度和HBV DNA水平对实现表面抗原转阴有很强的的预测价值。

进一步分析，基线前S2 抗原滴度<2000 ng/mL是HBsAg转阴的独立预测因素，治疗后24个月时前S2 抗原滴度<900 ng/mL与e抗原阳性患者HBeAg转阴密切相关。

原文阅读》》》Using Pre-S2 Antigen to Predict Treatment Response

Loss of surface antigen (HBsAg) in viral hepatitis usually indicates a clinical cure of hepatitis B infection. Researchers at the Ajoun University School of Medicine, South Korea, are suggesting that Pre-S2 antigen levels can be used to predict HBsAg and HBeAg loss during therapy with nucleos(t)ide analogues (NUCs).

The study considers 30 patients with chronic hepatitis B undergoing NUCs therapy. Surface antigen dropped to undetectable levels in half of these patients during the course of the therapy. Twenty-two of the 30 were positive for HBeAg and 14 of those lost the antigen during therapy, suggesting the virus was no longer actively replicating. 

In all patients, Pre-S2 antigen titres decreased. However, as Dr. Seon Joo Ahn notes “the level of Pre-S2 antigen was significantly higher in HBsAg-persistent patients than in the HBsAg-loss patients.”The levels dropped from an average of 1508 to 95 ng/mL in patients with HBsAg-loss, compared with 6024 to 2611 ng/mL in those without. 

The Pre-S2 antigen levels also correlated closely with baseline HBV DNA levels. When considering their values in combination, Pre-S2 antigen titers and HBV DNA levels showed strong predictive value for attaining surface antigen loss. 

When examined more closely, the data revealed that Pre-S2 antigen of <2000 ng/mL at baseline was an independent factor for HBsAg-loss and that Pre-S2 levels of <900 ng/mL at 24 months of treatment, was closely associated with HBeAg-loss in positive patients.

来源：APASL 2014 daily news

专家点评

魏来教授

　　韩国亚洲大学的Ahn等研究显示，核苷（酸）类似物治疗期间的血清前S2抗原水平与HBsAg消失有关。该研究共纳入了15例HBsAg消失和95例未获得HBsAg消失的患者。研究显示，基线前S2抗原水平<2000 ng/mL是HBsAg消失的独立预测因素，治疗24个月前S2抗原水平<900 ng/mL与HBeAg阳性患者HBsAg消失有关。前S2抗原消失发生在HBsAg消失之前。HBsAg消失接近临床治愈，因此，预测HBsAg消失能帮助个体化治疗和改善成本效益，很有吸引力。我们注意到，作者使用了基线数据和动态数据。不过，作者并没有介绍纳入标准和排除标准，也没有提供患者的基因分型背景资料。

评论来源：《国际肝病》