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标题: 在停止慢性乙型肝炎患者拉米夫定或替比夫定治疗后10年随访 [打印本页]

作者: StephenW 时间: 2015-8-10 17:44 标题: 在停止慢性乙型肝炎患者拉米夫定或替比夫定治疗后10年随访

Clin Microbiol Infect. 2015 Aug 4. pii: S1198-743X(15)00784-3. doi: 10.1016/j.cmi.2015.07.023. [Epub ahead of print]
10-years follow-up of hepatitis B relapse after cessation of lamivudine or telbivudine treatment in chronic hepatitis B patients.Pan HY1, Pan HY2, Chen L3, Yang DH4, Huang HJ5, Tong YX6, Chen CR7, Yan J8.
Author information

1Department of Infectious Diseases, Zhejiang Provincial People's Hospital, University of Zhejiang Chinese Medicine, Hangzhou, Zhejiang, China. Electronic address: [email protected].
2Department of Medicine, Pujiang People's Hospital, Zhejiang, China. Electronic address: [email protected].
3Zhejiang Chinese Medicinal University, Hangzhou, Zhejiang, China. Electronic address: [email protected].
4Department of Infectious Diseases, Zhejiang Provincial People's Hospital, University of Zhejiang Chinese Medicine, Hangzhou, Zhejiang, China. Electronic address: [email protected].
5Department of Infectious Diseases, Zhejiang Provincial People's Hospital, University of Zhejiang Chinese Medicine, Hangzhou, Zhejiang, China. Electronic address: [email protected].
6Department of Infectious Diseases, Zhejiang Provincial People's Hospital, University of Zhejiang Chinese Medicine, Hangzhou, Zhejiang, China. Electronic address: [email protected].
7Department of Internal Medicine, Hangzhou XiXi hospital, Hangzhou, Zhejiang, China. Electronic address: [email protected].
8Department of Internal Medicine, Hangzhou XiXi hospital, Hangzhou, Zhejiang, China. Electronic address: [email protected].

AbstractBACKGROUND & AIMS: The high rate of relapse after cessation of nucleos(t)ide analogues (NUCs) treatment in chronic hepatitis B (CHB) patients leads us to re-assess the feasibility for off-therapy, but long-term follow-up data are scarce. We assessed the feasibility for off-therapy by a long-term observation of relapse in response to lamivudine (LAM) and telbivudine (LdT).
METHODS: 86 NUCs-naïve CHB patients, treated with LAM (n=46) or LdT (n=40) who reached the guidelines recommended for off-therapy were followed for up to 10-years. Hepatitis B virus (HBV), viral serology and biochemistries were periodically determined. COX model was used to predict the risk of relapse.
RESULTS: 52.3% of patients relapsed within a median of 115-months (61-122). 93.3% of relapses occurred within 48-months. Relapse rates in HBeAg-positive (n=56) and HBeAg-negative (n=30) patients were 39.3% and 72.9%, respectively (P<0.01). HBeAg-positive patients who achieved an early viral response (EVR), defined as undetectable HBV-DNA within 6-months, had a lower relapse rate compared to non-EVR patients (21.4% versus 59.2%, P<0.01). EVR patients had both lower HBV-DNA (<106copies/mL) at baseline and lower HBsAg at end of treatment had a relapse rate of 10.7%.
CONCLUSIONS: The high relapse rates in CHB patients over this 10-years follow-up make LAM or LdT off-therapy infeasible in most of the cases, except in the case of HBsAg loss and/or seroconversion. HBeAg-positive patients with EVR, lower HBV-DNA, HBsAg had lower relapse rates and could be good candidates for off-therapy. Long-term monitoring, especially during the first 4 years, is critical for off-therapy patients.
Copyright © 2015. Published by Elsevier Ltd.

KEYWORDS: chronic; durability; hepatitis B; long-term; nucleoside analogues

作者: StephenW 时间: 2015-8-10 17:44

临床微生物传染。 2015年4月PII：S1198-743X（15）00784-3。 DOI：10.1016 / j.cmi.2015.07.023。 [打印EPUB的提前]
在停止慢性乙型肝炎患者拉米夫定或替比夫定治疗后10年随访的乙肝复发。
潘HY1，HY2潘，陈L3，杨DH4，黄HJ5，佟YX6，陈CR7，严J8。
作者信息

传染病教研室，浙江省人民医院，浙江中医药中国，杭州，浙江，中国的大学。电子地址：[email protected]。
医学教研室，浦江县人民医院，浙江，中国的。电子地址：[email protected]。
3Zhejiang中国药科大学，杭州，浙江，中国。电子地址：[email protected]。
传染病4Department，浙江省人民医院，浙江中医药中国，杭州，浙江，中国的大学。电子地址：[email protected]。
传染病5Department，浙江省人民医院，浙江中医药中国，杭州，浙江，中国的大学。电子地址：[email protected]。
传染病6Department，浙江省人民医院，浙江中医药中国，杭州，浙江，中国的大学。电子地址：[email protected]。
7Department内科，杭州西溪医院，杭州，浙江，中国的。电子地址：[email protected]。
8Department内科，杭州西溪医院，杭州，浙江，中国的。电子地址：[email protected]。

抽象
背景与目的：

高复发率戒烟核苷后慢性乙型肝炎（）类似物（NUCs）处理（CHB）患者引导我们重新评估场外治疗的可行性，但长期随访数据很少。我们评估了截止治疗的可行性通过长期观察复发响应于拉米夫定（LAM）和替比夫定（LDT）。
方法：

86 NUCs初治慢性乙肝患者，LAM（N = 46）或LDT（N = 40），谁达到建议场外治疗准则随后长达10年的处理。乙型肝炎病毒（HBV），病毒血清学和生化指标进行周期性地确定。 COX模型被用来预测复发的风险。
结果：

患者52.3％的115个月（61-122）中位数内复发。复发93.3％发生48个月内。在HBeAg阳性（N = 56）和HBeAg阴性（N = 30）的患者复发率分别为39.3％和72.9％（P <0.01）。谁取得了早期病毒应答（EVR）HBeAg阳性患者，6个月内被定义为不可检测HBV-DNA，有一个较低的复发率相比，非EVR的患者（21.4％对59.2％，P <0.01）。 EVR的患者在基线有两个下HBV-DNA（<106copies / mL）和较低的HBsAg在治疗结束了10.7％复发率。
结论：

高复发率的慢性乙肝患者在这个10年的随访化妆LAM或LDT场外治疗不可行，在大多数的情况下，除了在HBsAg消失和/或血清转换的情况下。 HBeAg阳性患者的EVR，降低HBV-DNA，乙肝表面抗原具有较低的复发率，可能是很好的人选离治疗。长期监测，尤其是在头4年，是为关断治疗患者的关键。

版权所有©2015年出版公司爱思唯尔
关键词：

慢性;耐用性;乙型肝炎;长期;核苷类似物

作者: 老折腾 时间: 2015-8-10 18:27

建议出国的大神把关键内容译一下，看得费劲

作者: 齐欢畅2 时间: 2015-8-10 21:39

CONCLUSIONS: The high relapse rates in CHB patients over this 10-years follow-up make LAM or LdT off-therapy infeasible in most of the cases, except in the case of HBsAg loss and/or seroconversion. HBeAg-positive patients with EVR, lower HBV-DNA, HBsAg had lower relapse rates and could be good candidates for off-therapy. Long-term monitoring, especially during the first 4 years, is critical for off-therapy patients.

作者: disan 时间: 2015-8-11 00:03

齐欢畅2 发表于 2015-8-10 21:39
CONCLUSIONS: The high relapse rates in CHB patients over this 10-years follow-up make LAM or LdT off ...

这个结论和德可关于ARC520的猜想一致。看来eAg+应该可以用520联合治疗了。
eAg+总体比例多少？10%?

作者: 齐欢畅2 时间: 2015-8-11 22:46

赞同楼上

作者: 相信会幸福 时间: 2015-8-11 23:07

大三阳比小三阳好治疗？

作者: jiankangren19 时间: 2015-8-12 06:25

小三阳太复杂了，有的真不如大三阳，但有的几乎接近痊愈了！不能一概而论。

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