Comparison of HBsAg and HBeAg Levels with HBV DNA and ALT Levels in Patients with Chronic Hepatitis B Infections

İmran SAĞLIK; Derya MUTLU; Gözde ÖNGÜT; Halide AKBAŞ; Hülya İren GÜVENÇ; Dilara ÖĞÜNÇ; Dilek  ÇOLAK

doi:10.4274/Vhd.84856

ABSTRACT

Objective:

Serologic markers, viral load determinations and serum ALT values are commonly used for diagnosis and treatment of chronic Hepatitis B virus infections. In recent years, HBsAg and HBeAg values has been raised to be associated with HBV DNA and ALT levels. The aim of this study is compare the HBsAg and HBeAg values with HBV DNA and ALT values.

Materials and Methods:

This study included 402 serum and plasma samples of 356 patients with chronic hepatitis B that were asked for determination of HBsAg, HBeAg and HBV DNA levels to Microbiology Laboratory of Akdeniz University Medical Faculty Hospital. HBsAg and HBeAg levels were measured by using the Modular Analitics E170 system (Roche Diagnostics, Germany). All samples were positive for HBsAg. ALT levels were detected by using the Roche Hitachi Cobas 8000 Modular Analyzer system (Roche Diagnostics, Germany). HBV DNA levels were determined by using Cobas Taqman assay (Roche Diagnostics, Germany).

Results:

When 51 of the serum samples which had HBsAg values up to 400 s/co were evaluated, there have been a positive correlation with HBsAg and HBV DNA values (p<0.001). In all of the samples, there have been a positive correlation with HBeAg s/co values and HBV DNA levels (p<0.001). HBV DNA levels and serum ALT levels were higher in patients with HBeAg positivity (n=107), when compared with patients who were negative for HBeAg (n=295) (p<0.001). HBV DNA and HBeAg s/co values were higher in patients with high serum ALT levels (n=112), when compared with patients who had normal ALT values (p<0.001).

Conclusion:

In patients with chronic Hepatitis B infection, HBeAg and HBsAg measurement values were positively correlated with HBV DNA levels. However, serum HBsAg levels must be measured with properly diluted samples. HBeAg s/co values, may be indicators for the existence of high ALT and HBV DNA values.

Keywords:

Chronic hepatitis B, HBsAg, HBeAg, HBV DNA

Giris

Hepatit B virüsü (HBV) tüm dünyada kronik karaciger hastaligina yol açan en önemli patojenlerden birisidir. Hepatit B enfeksiyonu tanisi genellikle hasta serumunda viral antijenlerin (HbsAg, HbeAg) ve/veya antikorlarin (Anti Hbs, Anti Hbe, Anti Hbc IgM-IgG) degerlendirilmesiyle konur. HBsAg, HBV enfeksiyonunu göstermek için en sik kullanilan temel belirteçtir (1). HbsAg’nin alti aydan uzun süre ile pozitif kalmasi, hepatit B enfeksiyonunun kroniklestiginin göstergesidir. Kronik hepatit B (KHB) hastalarinda klinik seyrin izlenmesinde HBsAg, HBeAg serokonversiyonu, HBV DNA ve alanin aminotransferaz (ALT) düzeylerinin takibi yol gösterici olmaktadir (2). HBsAg, HBeAg ve HBV DNA farkli, fakat birbirini tamamlayici parametrelerdir. HBV DNA ve HBeAg viral replikasyonun göstergesidir. HBsAg kompleks bir mekanizma ile üretilir ve serum HBsAg düzeyi ile karacigerdeki cccDNA’nin (covelently closed circular DNA) transkripsiyonel aktivitesi uyumlu bulunmustur. cccDNA’nin tespiti için invazif yöntemler gerekir (2-4). Son yillarda serolojik belirteçlerin tespitinde kullanilan otomatize ölçüm sistemlerinin gelismesi, HBsAg ve HBeAg düzeylerinin hastaligin seyrinde belirteç olarak kullanilabilecegini gündeme getirmistir. Ticari olarak kantitatif HBsAg ölçümü yapan iki farkli kit mevcuttur. Her iki kit de kantitasyon için serum örneklerine dilüsyon önermekte ve IU/ml olarak sonuç vermekte olup, kitlerin sonuçlari birbirleriyle uyumlu bulunmustur (5). Tani ve tedavi takibinde daha ucuz yöntem arayislari hepatit B serolojik belirteçleri ile hastalik seyrini ve/veya HBV DNA düzeylerini karsilastiran çesitli çalismalar yapilmasina yol açmistir (4). Bu çalismanin amaci, KHB hastalarinda elektrokemiluminesan yöntemle ölçülen yari kantitatif HBsAg, HBeAg ölçüm degerlerinin HBV DNA ve ALT düzeyleri ile karsilastirilmasidir.