关键词： HBV RNA HBcrAg HBeAg seroconversion children with chronic hepatitis B individualized therapy

Mesh ： Humans Hepatitis B, Chronic / drug therapy virology blood Male Female Child Seroconversion Hepatitis B e Antigens / blood Antiviral Agents / therapeutic use RNA, Viral / blood Hepatitis B virus / genetics immunology Adolescent Interferon-alpha / therapeutic use Child, Preschool Biomarkers / blood Guanine / therapeutic use analogs & derivatives Hepatitis B Core Antigens / blood immunology ROC Curve

来  源：   DOI：10.1002/jmv.29670

Abstract：
This study aimed to assess the predictive capacity of emerging serological markers, serum HBV RNA and HBcrAg, for HBeAg seroconversion in children with HBeAg-positive chronic hepatitis B (CHB). Treatment-naïve HBeAg-positive CHB children who admitted to the Liver Disease Center of Hunan Children\'s Hospital between April 2021 and September 2022 and received treatment with the combined entecavir and interferon-alpha treatment were recruited. Serum HBV RNA and HBcrAg were measured at baseline and Weeks 12, 24, and 48 of treatment. Our study showed that serum HBV RNA (HR = 0.71, 95% CI: 0.56-0.91, p = 0.006), HBcrAg (HR = 0.60, 95% CI: 0.43-0.84, p = 0.003), and HBsAg (HR = 0.49, 95%CI: 0.36-0.69, p < 0.001) at Week 12 were independent predictors of HBeAg seroconversion. ROC curve analysis presented that serum HBV RNA decline value (ΔHBV RNA) at Week 36 and HBcrAg decline value (ΔHBcrAg) at Week 12 (AUC = 0.871, p = 0.003 and AUC = 0.810, p = 0.003, respectively) could effectively predict HBeAg seroconversion. Furthermore, the optimal critical values were determined and the children with ΔHBV RNA > 3.759 log10 copies/mL at Week 36 or ΔHBcrAg >0.350 log10 U/mL at Week 12 more likely to achieve HBeAg seroconversion. The serum HBV RNA and HBcrAg provide new insights into the treatment of CHB in children. Early assessment of serum HBV RNA and HBcrAg during treatment can assist clinical decision-making and optimize individualized therapeutic approaches.
摘要：
本研究旨在评估新兴血清学标志物的预测能力，血清HBVRNA和HBcrAg，对于HBeAg阳性慢性乙型肝炎（CHB）儿童的HBeAg血清转换。在2021年4月至2022年9月期间入住湖南省儿童医院肝病中心并接受恩替卡韦和干扰素-α联合治疗的未治疗HBeAg阳性CHB儿童被招募。在基线和治疗的第12、24和48周测量血清HBVRNA和HBcrAg。我们的研究表明，血清HBVRNA（HR=0.71，95％CI：0.56-0.91，p=0.006），HBcrAg（HR=0.60，95％CI：0.43-0.84，p=0.003），和HBsAg（HR=0.49，95CI：0.36-0.69，p<0.001）在第12周是HBeAg血清转换的独立预测因子。ROC曲线分析表明，第36周的血清HBVRNA下降值（ΔHBVRNA）和第12周的HBcrAg下降值（ΔHBcrAg）（AUC=0.871，p=0.003和AUC=0.810，p=0.003）可以有效地预测HBeAg血清转换。此外，确定了最佳临界值，第36周时ΔHBVRNA>3.759log10拷贝/mL或第12周时ΔHBcrAg>0.350log10U/mL的儿童更有可能实现HBeAg血清转换。血清HBVRNA和HBcrAg为儿童CHB的治疗提供了新的见解。在治疗期间早期评估血清HBVRNA和HBcrAg可以帮助临床决策并优化个性化治疗方法。
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