The kinetics of serum hepatitis B surface antigen (HBsAg) during the natural history of hepatitis B virus (HBV) infection has been studied, but the factors affecting them remain unclear. We aimed to investigate the factors affecting HBsAg titres, using data from multicentre, large-sized clinical trials in China. The baseline data of 1795 patients in 3 multicentre trials were studied, and the patients were classified into 3 groups: hepatitis B early antigen (HBeAg)-positive chronic HBV infection (n = 588), HBeAg-positive chronic hepatitis B (n = 596), and HBeAg-negative chronic hepatitis B (n = 611). HBsAg titres in the different phases were compared, and multiple linear progression analyses were performed to investigate the implicated factors. HBsAg titres varied significantly in different phases (P = .000), with the highest (4.60 log10 IU/mL [10%-90% confidence interval: 3.52 log10 IU/mL-4.99 log10 IU/mL]) in patients with HBeAg-positive chronic HBV infection. In all phases, age and HBV DNA were correlated with serum HBsAg level. In HBeAg-positive chronic hepatitis B patients, a negative correlation between HBsAg titres and fibrosis stage was observed. Alanine amonitransferase or necroinflammatory activity was also correlated with HBsAg titres in HBeAg-negative chronic hepatitis B patients. In conclusion, decreased HBsAg titres may be associated with advancing fibrosis in HBeAg-positive chronic hepatitis B patients or increased necroinflammation in those with HBeAg-negative chronic hepatitis B. Our findings may help clinicians better understand the kinetics of HBsAg and provide useful insights into the management of this disease.
Background: According to previous studies, D-dimer levels are associated with prognosis in patients with pancreatic cancer (PC). However, the current results are limited and controversial. Therefore, we conducted this meta-analysis to assess the relationship between D-dimer levels and the prognosis and pathological characteristics of patients with PC. Method: A computer search of PubMed, Embase, The Cochrane Library, Web Of Science, CBM, VIP, CNKI and Wanfang databases was conducted to identify available studies. The association between pre-treatment d -dimer levels and the prognosis of PC patients was assessed using a combined hazard ratio (HR) and 95% confidence interval (CI). The combined odds ratio (OR) and 95% confidence in CI were applied to assess the relationship between D-dimer levels and the pathological characteristics of patients with PC. For all of the statistical analyses, Stata 12.0 software was used. Result: A total of 13 studies involving 2777 patients were included in this meta-analysis. The results showed that elevated pre-treatment d -dimer levels were significantly associated with worsening OS (HR = 1.46 95% CI: 1.34-1.59; p<0.001). We also performed subgroup analyses based on sample size, d -dimer threshold, follow-up time and source of HR to further validate the prognostic value of pre-treatment d -dimer levels in PC. In addition, according to the analysis, high pre-treatment d -dimer levels in PC patients were associated with late tumour stage (OR = 4.78, 95% CI 1.73-13.20, p<0.005), larger tumours (OR = 1.72, 95% CI 1.25 ~ 2.35, p<0.005) and distant metastases in tumours (OR = 5.06, 95% CI 2.45- 10.43, p<0.005) were significantly associated. In contrast, other clinicopathological factors, including age, sex and lymph node metastasis, were not associated with d -dimer levels. Conclusion: High levels of d-dimer prior to treatment are associated with poor prognosis in patients with PC and are associated with more advanced tumour stage, larger tumours and the occurrence of distant metastases. Plasma d-dimer levels can be used as a biomarker of prognosis in patients with PC.
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