- 期刊
定量B型肝炎表面抗原之應用
The Application of Quantification of Hepatitis B Surface Antigen
摘要
慢性B型肝炎與肝硬化、肝癌發生有關，追蹤病人病程與治療是全球尤其亞洲國家重要健康課題。透過一些生物指標（biomarkers），可掌握病程發展及預測治療效果。除常用的ALT（alanine transaminase)、HBeAg（hepatitis B envelop antigen）、HBV DNA（hepatitis B virus deoxyribonucleic acid）外，許多研究發現定量表面抗原（quantification of hepatitis B surface antigen，qHBsAg）濃度是一個有效指標。qHBsAg反映受感染肝細胞核內共價封閉環DNA（covalently closed circular DNA，ccc DNA）的活性，自然病程中qHBsAg於不活動帶原期（inactive carrier phase）最低。qHBsAg低預期將來HBsAg消失機會高。藥物治療之初qHBsAg低或治療期間qHBsAg降低多者，經治療達血清轉換（seroconversion）及病毒學反應（virologic response）機會高。治療期間qHBsAg降低量於使用長效干擾素（peginterferon）治療比使用類核苷（酸）藥物（nucleos(t)ide analogues，NAs）治療顯著。期望經更多研究，針對國人B型肝炎基因型訂出能反映達成穩定不活動帶原者（inactive carrier）終而HBsAg消失的qHBsAg切割值或降低量，作為B病人追蹤及治療的導引。
並列摘要
Chronic hepatitis B is related to development of liver cirrhosis and hepatocellular carcinoma. Monitoring and treatment for chronic hepatitis Bare important global health policies and are emphasized in Asian countries. According to some biomarkers, we estimate disease progress and predict the effect of treatment. In addition to ALT, HBeAg, HBV DNA, quantification of hepatitis B surface antigen (qHBsAg) is a valid biomarker for such application that was reported from many studies. During natural course, qHBsAg is lowest in the inactive phase. Low qHBsAg predicts chance for HBsAg loss. With treatment, low initial qHBsAg and rapid on-treatment decline in qHBsAg predict higher chance for seroconversion and virologic response. In comparison with nucleos(t)ide analogues, interferon-based therapy results in greater declines in qHBsAg level. More genotype-specific studies are needed to establish the cut-off value and the on-treatment qHBsAg level decline that reflect effective response to achieve inactive carrier and finally HBsAg loss.