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Z Gastroenterol 2016; 54(04): 319-326
DOI: 10.1055/s-0042-100286
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Diagnostischer Wert der quantitativen HBsAg-Bestimmung bei der Hepatitis B-Infektion

Diagnostic value of the quantitative HBsAg determination in hepatitis B infections
J. van Helden
1   MVZ Dr. Stein und Kollegen, Mönchengladbach, Germany
,
R. Weiskirchen
2   Institut für Molekulare Pathobiochemie, Experimentelle Gentherapie und Klinische Chemie, Uniklinik RWTH Aachen, Germany
› Author Affiliations
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Publication History

13 August 2015

07 January 2016

Publication Date:
07 April 2016 (online)

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Zusammenfassung

Die Einführung von systematischen Hepatitis B-Impfungen hat zwar zu einem starken Rückgang der Neuerkrankungen geführt, aber es gibt immer noch eine sehr hohe Anzahl von chronisch Infizierten, die an den Spätfolgen der Infektion leiden. Durch die quantitative Bestimmung der HBsAg-Konzentration (qHBsAg) hat sich unser Verständnis der chronischen Hepatitis B (CHB) verbessert. In den verschiedenen Infektionsphasen werden stark unterschiedliche HBsAg-Konzentrationen gemessen. Durch die quantitative HBsAg-Bestimmung erhält man nicht nur zusätzliche Informationen zur Infektionsaktivität, sie eröffnet auch neben der Bestimmung der Viruslast zusätzliche, unabhängige Informationen zur Verlaufsbeobachtung. Als unabhängiger prognostischer Marker weist sie auf ein erhöhtes Risiko für die Entwicklung einer Zirrhose oder ein hepatozelluläres Karzinom (HCC) hin. qHBsAg wird eingesetzt zum Therapiemonitoring bei der PEG-Interferon-Therapie. Bei der Therapie mit Nukleos(t)id-Analoga (NUC) korreliert der HBsAg-Abfall zwar nicht mit dem rascheren Absinken der HBV-DNA. Trotzdem kann man bei rapidem HBsAg-Abfall die Patienten identifizieren, die letztlich HBsAg eliminieren werden. Unter der NUC-Therapie wird daher eine 6 – 12-monatige Kontrolle der HBsAg-Spiegel empfohlen. Aufgrund dieses zusätzlichen Informationsgewinns wird durch die qHBsAg-Bestimmung neben der Messung der Viruslast das Management von Patienten mit chronischer Hepatitis B-Infektion deutlich verbessert.

Abstract

Introduction of systematic hepatitis B vaccination has lead to a strong decrease of new infections, but there are still a high numbers of chronically infected persons suffering on long-term complications. Using quantitative assays for the determination of HbsAg (qHBsAg) has improved our understanding of chronic hepatitis B (CHB). The concentrations of HBsAg are strongly varying through the different stages of infection. The quantitative determination of HBsAg does not only yield in additional information to the infection activity, but also provides data for an improved follow up independent from the virus load. As to the prediction of disease progression, low-viremic carriers with high HbsAg levels have been shown to be at higher risk of HBeAg negative hepatitis, cirrhosis and hepatocellular carcinoma (HCC). Although, quantitative HBsAg determination has been widely used in CHB patients receiving pegylated interferon therapy, the HbsAg decline is slow compared to HBV-DNA levels during nucleos(t)ide analogue (NUC) therapy. However a rapid HbsAg decline during NUC therapy may identify patients who will finally clear HbsAg. A 6- to 12-monthly assessment of HbsAg level could be considered during NUC therapy. Taking these lines of evidence together, qHBsAg can complement HBV-DNA levels to optimize the management of CHB patients.

Schlüsselwörter

Hepatitis B - Virushepatitis - Leber

Key words

hepatitis B - virus hepatitis - liver
 

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