肝脏 ›› 2024, Vol. 29 ›› Issue (9): 1024-1028.
刘世超, 黄嘉敏, 伍婷, 黄国仪, 董京科, 王方, 何清
收稿日期:
2024-07-28
出版日期:
2024-09-30
发布日期:
2024-11-13
通讯作者:
何清, Email: heqingjoe@163.com
基金资助:
Received:
2024-07-28
Online:
2024-09-30
Published:
2024-11-13
摘要: 乙型肝炎核心相关抗原(HBcrAg)作为一种新兴生物标记物,在慢性乙型肝炎(CHB)的诊断与治疗中扮演着关键角色。它与血清中的HBV DNA以及肝脏内的cccDNA均呈相关性。即使在血清HBV DNA无法检测或乙型肝炎表面抗原(HBsAg)缺失的情况下,HBcrAg依然可被检出。值得注意的是,HBcrAg水平的下降与CHB患者预后密切相关。本综述基于HBcrAg的病毒学特征对预测CHB患者功能性治愈的价值及其临床应用进行阐述。然而,目前关于HBcrAg的研究尚处于初级阶段,其在CHB诊断和治疗过程中的具体应用仍未形成广泛共识,故需要进一步的深入研究以明确其作用。
刘世超, 黄嘉敏, 伍婷, 黄国仪, 董京科, 王方, 何清. 新型标记物HBcrAg预测CHB功能性治愈及其临床价值的研究进展[J]. 肝脏, 2024, 29(9): 1024-1028.
[1] Sarin S K, Kumar M, Lau G K, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update[J]. Hepatol Int, 2016,10(1):1-98. [2] Terrault N A, Lok A, McMahon B J, et al. Update on Prevention, Diagnosis, and Treatment of Chronic Hepatitis B: AASLD 2018 Hepatitis B Guidance[J]. Clin Liver Dis (Hoboken), 2018,12(1):33-34. [3] EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[J]. J Hepatol, 2017,67(2):370-398. [4] Pan C Q, Li M H, Yi W, et al. Outcome of Chinese patients with hepatitis B at 96 weeks after functional cure with IFN versus combination regimens[J]. Liver Int, 2021,41(7):1498-1508. [5] Tang L, Covert E, Wilson E, et al. Chronic Hepatitis B Infection: A Review[J]. JAMA, 2018,319(17):1802-1813. [6] Salimzadeh L, Le Bert N, Dutertre C A, et al. PD-1 blockade partially recovers dysfunctional virus-specific B cells in chronic hepatitis B infection[J]. J Clin Invest, 2018,128(10):4573-4587. [7] Lok A S, Zoulim F, Dusheiko G, et al. Hepatitis B cure: From discovery to regulatory approval[J]. Hepatology, 2017,66(4):1296-1313. [8] 尤红, 王福生, 李太生, 等. 慢性乙型肝炎防治指南(2022年版)[J]. 实用肝脏病杂志, 2023,26(03):457-478. [9] Kimura T, Ohno N, Terada N, et al. Hepatitis B virus DNA-negative dane particles lack core protein but contain a 22-kDa precore protein without C-terminal arginine-rich domain[J]. J Biol Chem, 2005,280(23):21713-21719. [10] Song G, Yang R, Rao H, et al. Serum HBV core-related antigen is a good predictor for spontaneous HBeAg seroconversion in chronic hepatitis B patients[J]. J Med Virol, 2017,89(3):463-468. [11] Lin C L, Kao J H. New perspectives of biomarkers for the management of chronic hepatitis B[J]. Clin Mol Hepatol, 2016,22(4):423-431. [12] Yip T C, Wong V W, Tse Y K, et al. Similarly low risk of hepatocellular carcinoma after either spontaneous or nucleos(t)ide analogue-induced hepatitis B surface antigen loss[J]. Aliment Pharmacol Ther, 2021,53(2):321-331. [13] Cornberg M, Lok A S, Terrault N A, 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]. Hepatology, 2019. [14] Seto W K, Wong D K, Fung J, et al. Linearized hepatitis B surface antigen and hepatitis B core-related antigen in the natural history of chronic hepatitis B[J]. Clin Microbiol Infect, 2014,20(11):1173-1180. [15] Sonneveld M J, Chiu S M, Park J Y, et al. Probability of HBsAg loss after nucleo(s)tide analogue withdrawal depends on HBV genotype and viral antigen levels[J]. J Hepatol, 2022,76(5):1042-1050. [16] Mak L Y, Wong D, Kuchta A, et al. Hepatitis B virus pre-genomic RNA and hepatitis B core-related antigen reductions at week 4 predict favourable hepatitis B surface antigen response upon long-term nucleos(t)ide analogue in chronic hepatitis B[J]. Clin Mol Hepatol, 2023,29(1):146-162. [17] Riveiro-Barciela M, Bes M, Rodríguez-Frías F, et al. Serum hepatitis B core-related antigen is more accurate than hepatitis B surface antigen to identify inactive carriers, regardless of hepatitis B virus genotype[J]. Clin Microbiol Infect, 2017,23(11):860-867. [18] Carey I, Gersch J, Wang B, et al. Pregenomic HBV RNA and Hepatitis B Core-Related Antigen Predict Outcomes in Hepatitis B e Antigen-Negative Chronic Hepatitis B Patients Suppressed on Nucleos(T)ide Analogue Therapy[J]. Hepatology, 2020,72(1):42-57. [19] Matsumoto A, Yatsuhashi H, Nagaoka S, et al. Factors associated with the effect of interferon-α sequential therapy in order to discontinue nucleoside/nucleotide analog treatment in patients with chronic hepatitis B[J]. Hepatol Res, 2015,45(12):1195-1202. [20] Kuo Y H, Wang J H, Hung C H, et al. Combining end-of-treatment HBsAg and baseline hepatitis B core-related antigen reduce HBV relapse rate after tenofovir cessation[J]. Hepatol Int, 2021,15(2):301-309. [21] Wong D K, Tanaka Y, Lai C L, et al. Hepatitis B virus core-related antigens as markers for monitoring chronic hepatitis B infection[J]. J Clin Microbiol, 2007,45(12):3942-3947. [22] Rokuhara A, Sun X, Tanaka E, et al. Hepatitis B virus core and core-related antigen quantitation in Chinese patients with chronic genotype B and C hepatitis B virus infection[J]. J Gastroenterol Hepatol, 2005,20(11):1726-1730. [23] Wong D K, Seto W K, Cheung K S, et al. Hepatitis B virus core-related antigen as a surrogate marker for covalently closed circular DNA[J]. Liver Int, 2017,37(7):995-1001. [24] Kimura T, Rokuhara A, Sakamoto Y, et al. Sensitive enzyme immunoassay for hepatitis B virus core-related antigens and their correlation to virus load[J]. J Clin Microbiol, 2002,40(2):439-445. [25] Seto W K, Tanaka Y, Wong D K, et al. Evidence of serologic activity in chronic hepatitis B after surface antigen (HBsAg) seroclearance documented by conventional HBsAg assay[J]. Hepatol Int, 2012,7(1):98-105. [26] Loggi E, Vukotic R, Conti F, et al. Serum hepatitis B core-related antigen is an effective tool to categorize patients with HBeAg-negative chronic hepatitis B[J]. J Viral Hepat, 2019,26(5):568-575. [27] Tong S, Revill P. Overview of hepatitis B viral replication and genetic variability[J]. J Hepatol, 2016,64(1 Suppl):S4-S16. [28] Testoni B, Levrero M, Zoulim F. Challenges to a Cure for HBV Infection[J]. Semin Liver Dis, 2017,37(3):231-242. [29] Liu D, Xu T, Shi B, et al. Clinical relevance of the in situ assay for HBV DNA: a cross-sectional study in patients with chronic hepatitis B[J]. J Clin Pathol, 2020,73(12):813-818. [30] Zhang X, Lu W, Zheng Y, et al. In situ analysis of intrahepatic virological events in chronic hepatitis B virus infection[J]. J Clin Invest, 2016,126(3):1079-1092. [31] Wong D K, Yuen M F, Yuan H, et al. Quantitation of covalently closed circular hepatitis B virus DNA in chronic hepatitis B patients[J]. Hepatology, 2004,40(3):727-737. [32] Wong D K, Seto W K, Fung J, et al. Reduction of hepatitis B surface antigen and covalently closed circular DNA by nucleos(t)ide analogues of different potency[J]. Clin Gastroenterol Hepatol, 2013,11(8):1004-1010. [33] Hasegawa K, Nishikawa H, Enomoto H, et al. Proposed model for the prediction of intrahepatic covalently closed circular DNA level in patients with chronic hepatitis B[J]. Hepatol Res, 2019,49(3):271-283. [34] Suzuki F, Miyakoshi H, Kobayashi M, et al. Correlation between serum hepatitis B virus core-related antigen and intrahepatic covalently closed circular DNA in chronic hepatitis B patients[J]. J Med Virol, 2009,81(1):27-33. [35] Chen E Q, Feng S, Wang M L, et al. Serum hepatitis B core-related antigen is a satisfactory surrogate marker of intrahepatic covalently closed circular DNA in chronic hepatitis B[J]. Sci Rep, 2017,7(1):173. [36] Tanaka E, Matsumoto A, Suzuki F, et al. Measurement of hepatitis B virus core-related antigen is valuable for identifying patients who are at low risk of lamivudine resistance[J]. Liver Int, 2006,26(1):90-96. [37] Wang L, Cao X, Wang Z, et al. Correlation of HBcrAg with Intrahepatic Hepatitis B Virus Total DNA and Covalently Closed Circular DNA in HBeAg-Positive Chronic Hepatitis B Patients[J]. J Clin Microbiol, 2019,57(1). [38] Lenci I, Tisone G, Di Paolo D, et al. Safety of complete and sustained prophylaxis withdrawal in patients liver-transplanted for HBV-related cirrhosis at low risk of HBV recurrence[J]. J Hepatol, 2011,55(3):587-593. [39] Revill P A, Chisari F V, Block J M, et al. A global scientific strategy to cure hepatitis B[J]. Lancet Gastroenterol Hepatol, 2019,4(7):545-558. [40] Nguyen K, Pan C, Xia V, et al. Clinical course of chronic hepatitis B (CHB) presented with normal ALT in Asian American patients[J]. J Viral Hepat, 2015,22(10):809-816. [41] Zhao J, Bian D, Liao H, et al. Serum HBsAg and HBcrAg is associated with inflammation in HBeAg-positive chronic hepatitis B patients[J]. Front Cell Infect Microbiol, 2023,13:1083912. [42] Zhang Z Q, Lu W, Wang Y B, et al. Measurement of the hepatitis B core-related antigen is valuable for predicting the pathological status of liver tissues in chronic hepatitis B patients[J]. J Virol Methods, 2016,235:92-98. [43] Misawa N, Matsumoto A, Tanaka E, et al. Patients with and without loss of hepatitis B virus DNA after hepatitis B e antigen seroconversion have different virological characteristics[J]. J Med Virol, 2006,78(1):68-73. [44] Tada T, Kumada T, Toyoda H, et al. Hepatitis B virus core-related antigen levels predict progression to liver cirrhosis in hepatitis B carriers[J]. J Gastroenterol Hepatol, 2018,33(4):918-925. [45] Tada T, Kumada T, Toyoda H, et al. HBcrAg predicts hepatocellular carcinoma development: An analysis using time-dependent receiver operating characteristics[J]. J Hepatol, 2016,65(1):48-56. [46] Cheung K S, Seto W K, Wong D K, et al. Relationship between HBsAg, HBcrAg and hepatocellular carcinoma in patients with undetectable HBV DNA under nucleos(t)ide therapy[J]. J Viral Hepat, 2017,24(8):654-661. [47] Tseng T C, Liu C J, Hsu C Y, et al. High Level of Hepatitis B Core-Related Antigen Associated With Increased Risk of Hepatocellular Carcinoma in Patients With Chronic HBV Infection of Intermediate Viral Load[J]. Gastroenterology, 2019,157(6):1518-1529. [48] Höner Z S C, Maasoumy B, Cornberg M. What is new on HBsAg and other diagnostic markers in HBV infection?[J]. Best Pract Res Clin Gastroenterol, 2017,31(3):281-289. [49] Kumada T, Toyoda H, Tada T, et al. Effect of nucleos(t)ide analogue therapy on hepatocarcinogenesis in chronic hepatitis B patients: a propensity score analysis[J]. J Hepatol, 2013,58(3):427-433. [50] Honda M, Shirasaki T, Terashima T, et al. Hepatitis B Virus (HBV) Core-Related Antigen During Nucleos(t)ide Analog Therapy Is Related to Intra-hepatic HBV Replication and Development of Hepatocellular Carcinoma[J]. J Infect Dis, 2016,213(7):1096-1106. [51] Hosaka T, Suzuki F, Kobayashi M, et al. Impact of hepatitis B core-related antigen on the incidence of hepatocellular carcinoma in patients treated with nucleos(t)ide analogues[J]. Aliment Pharmacol Ther, 2019,49(4):457-471. [52] Suzuki Y, Maekawa S, Komatsu N, et al. Hepatitis B virus (HBV)-infected patients with low hepatitis B surface antigen and high hepatitis B core-related antigen titers have a high risk of HBV-related hepatocellular carcinoma[J]. Hepatol Res, 2019,49(1):51-63. [53] Beudeker B, Groothuismink Z, de Man R A, et al. Hepatitis B core-related antigen levels predict recurrence-free survival in patients with HBV-associated early-stage hepatocellular carcinoma: results from a Dutch long-term follow-up study[J]. J Viral Hepat, 2021,28(1):205-208. [54] Hosaka T, Suzuki F, Kobayashi M, et al. HBcrAg is a predictor of post-treatment recurrence of hepatocellular carcinoma during antiviral therapy[J]. Liver Int, 2010,30(10):1461-1470. |
[1] | 何谱, 刘文宗. 抗病毒治疗慢性乙型肝炎患者发生低病毒血症的危险因素[J]. 肝脏, 2024, 29(9): 1105-1108. |
[2] | 金燚, 沈泳利, 李佟. 核苷(酸)类似物经治的慢性乙型肝炎患者低病毒血症的研究进展[J]. 肝脏, 2024, 29(8): 896-899. |
[3] | 杨丽, 孙君. 慢性乙型肝炎患者HBV DNA载量与血清miR-122、miR-223水平的关系[J]. 肝脏, 2024, 29(8): 947-951. |
[4] | 孔维菊, 任传路, 周昱岐, 李竞争, 何清, 袁俊菲. 血清PIVKA-Ⅱ在HBV相关肝癌患者中的表达及其与肝功能的相关性[J]. 肝脏, 2024, 29(7): 794-797. |
[5] | 刘艳午, 田丹, 宋晶晶. 超声剪切波弹性成像结合血浆NRG4水平评估慢性乙型肝炎肝纤维化程度的价值[J]. 肝脏, 2024, 29(7): 825-829. |
[6] | 刘明, 郭艳, 陈文婷, 况雪梅, 李世炼, 揭丽, 夏杰, 毛青, 朱研. HBeAg阳性妊娠慢性HBV携带者母婴阻断停药后肝炎活动的危险因素研究[J]. 肝脏, 2024, 29(7): 834-839. |
[7] | 谢艳迪, 张昕怡, 封波. HBeAg阴性慢性HBV感染期患者的临床治愈及影响因素[J]. 肝脏, 2024, 29(6): 631-634. |
[8] | 郝坤艳, 陈宇星, 汪文洋, 朱浩, 沈敏, 阳文新, 于乐成. 聚乙二醇干扰素对核苷(酸)类似物经治与未治的HBsAg低水平慢性乙型肝炎患者48周疗效比较[J]. 肝脏, 2024, 29(6): 635-640. |
[9] | 王春菊, 高嘉敏, 李丽容. 慢性乙型肝炎患者甲状腺激素水平与HBsAg水平及病情严重程度的相关性分析[J]. 肝脏, 2024, 29(6): 641-644. |
[10] | 宋舒瑛, 谢青, 姜绍文. 乙型肝炎治愈的临床研究进展[J]. 肝脏, 2024, 29(6): 725-730. |
[11] | 汪蕾, 陈晨, 华喜梅, 胡丰芬. 血清β-arrestin 2、HIF-1a及CA125联合预测慢性乙型肝炎肝纤维化的价值[J]. 肝脏, 2024, 29(5): 521-525. |
[12] | 李明慧, 王麟, 鲁凤民. 慢性乙型肝炎常见PC/BCP突变的可能致病机制[J]. 肝脏, 2024, 29(4): 371-373. |
[13] | 刘韵, 徐云, 韩亮, 钱艺, 谭碧波. 实时组织弹性成像评估慢性乙型肝炎患者食管静脉曲张的研究[J]. 肝脏, 2024, 29(4): 423-428. |
[14] | 蔡云, 赵凯, 潘良, 周鑫. IL-21参与HBeAg阳性慢性乙型肝炎的免疫发病机制的研究[J]. 肝脏, 2024, 29(4): 436-439. |
[15] | 余姣, 万谟彬. HBeAg阴性慢性乙型肝炎患者长期核苷(酸)类似物治疗停药后的随访及管理[J]. 肝脏, 2024, 29(3): 263-265. |
阅读次数 | ||||||
全文 |
|
|||||
摘要 |
|
|||||