SỰ THAY ĐỔI NỒNG ĐỘ HBCRAG TRONG QUÁ TRÌNH ĐIỀU TRỊ VIÊM GAN B MẠN TÍNH BẰNG THUỐC NUCLEOT(S)IDE VÀ MỐI TƯƠNG QUAN VỚI CÁC DẤU ẤN SINH HỌC

Abstract

HBcrAg- Hepatitis B core related antigen combines three proteins encoded by the core/precore region: HBcAg, HBeAg, and the 22-kDa precore protein (p22cr). Recent researchsindicates that HBcrAg plays an important role in clinical applications such as:HBcrAg can help predict spontaneous or treatment-induced HBeAg seroconversion, hepatitis B virus (HBV) reactivation, HBV reinfection after liver transplantation, and risk of progression or recurrence of HCC. HBcrAg levels correlates with HBV DNAload and intrahepatic HBVcccDNA. Specialy, cases with undetectable serumHBV DNA or loss of HBsAg, HBcrAg can still be detected, and the reduction in HBcrAg levels was significantly associated with treatment outcome of CHB. In Vietnam, there are few studies on HBcrAg, so we conducted the topic: Survey of HBcrAg concentration changes during the treatment of CHB with nucleot(s)ide drugs (NAs) and correlation with biomarkers, with two objectives: 1. Survey of HBcrAg concentration in CHB being treated with NAs. 2. Evaluate changes in HBcrAg concentration during the treatment of CHB with NAs and correlation with other biomarkers. Subjects and methods: CHB≥18 years-old without cirrhosis who are being treated with NAs for 2-4 years and has serum HBVDNA undetected. Prospective study, observing a series of cases. Results: A cross-sectional study of 325CHB (Male 56.6%, Age 30-49: 69.2% and HBeAg(+) 38,2%) showed that HBcrAg in patients with HBeAg(+) (5.56± 0,96) was higher than that in the neg group (3.43 ± 1.10) (p<0.05), the difference in HBcrAg concentration between age groups was statistically significant while there was no difference according to the years of treatment. During NAs treatment, although HBV-DNA had been undetected, HBcrAg concentration remained and continued to decrease. HBcrAg concentrations at M0, 6 and 12 months were 4.795 logU/ml, 4.516 logU/ml, and 4.528 logU/ml, respectively (p= 0.001). But there are no difference between the HBeAg(-) and (+) groups. HBcrAg concentration of 4.95 logU/ml had a predictive value for HBe seroconversion with AUC = 0.672 (95% CI, 0.592-0.751), sensitivity 81%, specificity 67%, PPV 57.1%, NPV 66.9%. Conclusions: HBcrAg concentrations were different between the HBeAg(-) and (+) groups, between age groups, however, there was no difference between groups with different treatment times. Although HBV-DNA was undetected, HBcrAg has remainded, still decreased and be a useful marker in predicting HBe seroconversion.