Objective To perform a systematic review on the predictive value of serum HBsAg levels in patients with HBeAg positive chronic hepatitis B(CHB)treated with nucleos(t)ide analogues(NAs). Methods A systematic search was performed on clinical trials regarding quantitative detection of serum HBsAg before and after antiviral treatment with NAs in patients with HBeAg positive CHB in PubMed,EMBASE and Cochrane Central Register between January 1,2006 and August 1,2016. Data was extracted by two reviewers independently. Statistical analysis was performed by using RevMan 5.2. HBsAg response was defined as serum HBsAg levels declined more than 1 lg IU/mL from baseline levels within 1 year after treatment with NAs. The other observation indexes were baseline HBsAg levels,HBeAg seroconversion and HBsAg loss. Results 10 eligible studies(467 patients in total)were enrolled in this Meta-analysis. The rate of HBeAg seroconversion in patients with HBsAg response was 64.3%,significantly higher than 19.8% in patients without HBsAg response(P<0.0001);the rate of HBsAg loss in patients with HBsAg response was 30.5%,also significantly higher than 0.4% in patients without HBsAg response(P<0.05);the baseline HBsAg levels were not shown different between patients with,(3.4±0.6 lg IU/mL)and paitents without HBeAg seroconversion(3.7 ±0.4 lg IU/mL,P﹥0.05). Conclusions During the treatment with NAs,a rapid decline of serum HBsAg levels might predict serological response in HBeAg positive CHB patients.%目的 系统评价HBeAg阳性慢性乙型肝炎(CHB)患者在接受核苷(酸)类药物(NAs)治疗过程中HBsAg的动态变化对血清学转换的预测价值.方法 检索PubMed、EMBASE、Cochrane Central Register数据库中关于HBsAg水平与HBeAg阳性的CHB患者在接受NAs治疗过程中发生血清学转换关系的临床研究.应用RevMan 5.2软件.结果 研究共纳入10篇文献,包括467例CHB患者.HBeAg阳性患者发生HBsAg应答组HBeAg血清学转换率为64.3%,显著高于未发生HBsAg应答组的19.8%(P<0.0001);HBsAg应答组HBsAg消失率为30.5%,显著高于未发生HBsAg应答组的0.4%(P<0.05);发生HBeAg血清学转换患者HBsAg基线水平为(3.4±0.6)lg IU/mL,与未发生HBeAg血清学转换患者的(3.7±0.4)lg IU/mL比,无显著差异(P>0.05).结论 HBeAg阳性患者在NAs抗病毒治疗过程中,HBsAg早期快速下降是患者发生HBeAg血清学转换的有效预测因素,甚至对HBsAg的消失也有一定的预测作用.
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