Meryem DEMİRELLİ, Necla TÜLEK, Fatih TEMOÇİN, Doğan YÜCEL, Fatma Şebnem ERDİNÇ, Günay ERTEM

Tedavi alan kronik hepatit B hastalarında serum kantitatif HBsAg düzeyi ile viral yük arasındaki ilişkinin araştırılması

ÖZET Amaç: Yakın geçmişe kadar HBsAg sadece hepatit B enfeksiyonun tanısında kullanılırken, günümüzde serum HBsAg kantitasyonu (qHBsAg)’nun, hepatit B virüsü (HBV) enfeksiyonunun viral monitörizasyonunda kullanılabileceğine dair veriler artmaya başlamıştır. Bu çalışmada inaktif hepatit B taşıyıcıları ile kronik aktif hepatit B hastaları arasındaki qHBsAg ile HBV DNA düzeyleri karşılaştırılmış ve tedavi başlanmış hastalarda tedavi süresince qHBsAg ile HBVDNA seyri izlenerek aralarındaki ilişki değerlendirilmiştir. Materyal ve Metod: Çalışma Ankara Eğitim ve Araştırma Hastanesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji kliniği’nde yapılmıştır. Kronik hepatit B (KHB) tanısıyla tedavi alan 71 hasta ve inaktif HBsAg taşıyıcısı 74 hasta çalışmaya dahil edildi. Bu hastalarda serum qHBsAg düzeyleri Elecsys HBsAg II cihazı ile çalışıldı. Bulgular: Nükleoz(t)id analoğu ile tedavi edilen hastalarda 6. ve 12. aydaki serum qHBsAg düzeyi ile HBV-DNA arasında pozitif yönde bir korelasyon görüldü ve her iki parametrenin altı ay ve bir yıllık izlemindeki düşüş istatiksel olarak anlamlı bulundu (qHBsAg 6ay p=0,03, qHBsAg 12 ay p=0,001, HBV DNA 6 ay p=0,001, HBV DNA 12 ay p=0,001). Peg-IFN tedavisi alan kronik hepatit B hastalarında ise serum qHBsAg düzeyi ile HBV-DNA arasında tedavi başlangıcı ve 6. ayında anlamlı bir ilişki olmayıp tedavi sonunda pozitif yönde korelasyon görüldü. PEG-IFN tedavisi alan hasta grubunda ise qHBsAg seviyeleri ile HBV DNA arasındaki korelasyon tedavi sonunda anlamlı (p=0,01) olarak saptandı. Sonuç: Bizim bulgularımız qHBsAg’nin, inaktif HBsAg taşıyıcıları ve KHB hastalarını ayırmada HBV-DNA düzeyleri birlikte kullanıldığında oldukça faydalı bir test olabileceği ve tedavi kararında ve takibinde qHBSAg seviyelerinin kullanılabileceğini düşündürmektedir.

Anahtar Kelimeler:

Kronik Hepatit B, inaktif HBsAg taşıyıcılığı, qHBsAg, PEG-IFN, nükleoz(t)id analogları

Investigation of the association of serum quantitative HBsAg levels with viral load in chronic hepatitis B Patients receiving treatment

Study Aims: The Hepatitis B surface antigen (HBsAg) test was only used for diagnosis of hepatitis B infection, whereas now there is growing evidence favoring utilization of serum HBsAg quantitation (qHBsAg) for monitoring of infection with hepatitis B virus (HBV). In our study, we examined the courses of qHBsAg and HBV-DNA levels throughout the treatment course of patients receiving treatment for chronic hepatitis B infection and evaluated their correlation with each other. Material and Methods: The study was performed Ankara Training and Research Hospital. A total of 71 patients receiving treatment for the diagnosis of chronic hepatitis B (CHB) infection were included in the study. Serum qHBsAg levels of these patients were analyzed with an Elecsys HBsAg II assay. Results: When we evaluated the correlation of serum qHBsAg levels with the HBV-DNA levels among patients treated with nucleotide analogues, there was a positive correlation. The decline in both parameters at sixth and 12 month follow-up was found to be statistically significant (qHBsAg decline at 6th month: p = 0.03; qHBsAg decline at 12th month: p = 0.001; HBV-DNA decline at 6th month: p = 0.001; HBV-DNA decline at12th month: p = 0.001). In the group of patients receiving PEG-IFN treatment, there was positive correlation between the two at the end of the treatment (p = 0.01). Conclusion: Our findings suggest that qHBsAg may be used for both the treatment decision and monitoring of treatment.

Keywords:

Chronic Hepatitis B, qHBsAg, PEG-IFN, , Nucleotide analogues.,

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