拉米夫定治疗停止治疗后乙肝患者的临床过程：分析138例

StephenW

http://www.virologyj.com/content/9/1/239/abstract
Clinical course of chronic hepatitis B patients who were off-treated after lamivudine treatment: analysis of 138 consecutive patients
拉米夫定治疗停止治疗后乙肝患者的临床过程：分析138例

Young-Joo Jin, Kang Mo Kim, Dong-jun Yoo, Ju Hyun Shim, Han Chu Lee, Young-Hwa Chung, Yung Sang Lee and Dong Jin Suh   


Virology Journal 2012, 9:239 doi:10.1186/1743-422X-9-239
Published: 18 October 2012
Abstract (provisional)

Background/aims

Little is known about the long-term outcome of chronic hepatitis B (CHB) patients who discontinued antiviral therapy. We intended to analyze the long-term outcome of CHB patients who discontinued lamivudine therapy and to evaluate predictors for post-treatment outcome.

Material/methods

From 2007 to 2008, 138 lamivudine off-treated CHB patients with alanine aminotransferase normalization were consecutively enrolled. Post-treatment virologic relapse, biochemical breakthrough, hepatitis flare, and retreatment results were retrospectively analyzed.
Results

Among 138 patients, 102 were initially HBeAg-positive at the start of lamivudine treatment. Virologic relapse, biochemical breakthrough, and hepatitis flare were observed in 45.2, 52.9, and 12.7% of HBeAg-positive and 29.4, 30.6, and 8.3% of HBeAg-negative patients during the median follow-up of 28 and 30 months, respectively. The cumulative virologic relapse and biochemical breakthrough rates were significantly lower in patients with HBV DNA <50 copies/mL than 50-104 copies/mL at lamivudine cessation. Hepatitis flare was observed in 4.8 and 11.8% of HBeAg-positive and HBeAg-negative patients with HBV DNA <50copies/mL, respectively. Thirty-eight among 138 patients received retreatment and most of them achieved biochemical (37/38) and virologic response (35/38) within 1 year of retreatment. Undetectable serum HBV DNA (<50 copies/mL) and young age at lamivudine cessation were inversely associated with virologic relapse. Undetectable HBV DNA at cessation, female, and initial HBeAg-negative were inversely associated with biochemical breakthrough.
Conclusions

Post-treatment virologic relapse and biochemical breakthrough incidence were low in patients who achieved undetectable viral titer at lamivudine cessation. Retreatment after biochemical breakthrough or virologic relapse was safe and effective. Intermittent antiviral therapy might be cautiously considered in appropriately selected CHB patients.

StephenW

背景/目的

鲜为人知的是，慢性乙型肝炎（CHB）患者终止抗病毒治疗的长期结果。我们要分析谁终止拉米夫定治疗慢性乙型肝炎患者的长期结果和评估后处理结果的预测。

材料/方法

从2007年至2008年，连续入选138关闭拉米夫定治疗的慢性乙型肝炎患者谷丙转氨酶正常化。治疗后病毒学复发，生化突破，肝炎爆发和再处理结果进行回顾性分析。
结果

在138例患者中，102例最初开始拉米夫定治疗HBeAg阳性。病毒学复发，生化突破，肝炎爆发，观察在45.2，52.9，12.7％的HBeAg阳性和29.4，30.6，和8.3％的HBeAg阴性患者的中位随访28个月和30个月期间，分别。的累积的病毒学复发和生化突破率显着降低，患者的HBV DNA <50拷贝/毫升50-104拷贝/毫升拉米夫定停止。肝炎耀斑观察，分别在4.8和11.8％，HBeAg阳性和HBeAg阴性患者HBV DNA <50copies/mL。在138例患者中36个接受再治疗，其中大部分实现了生化（37/38）和病毒学应答（35/38），1年以内，复治。检测不到血清HBV DNA（<50拷贝/ mL）和拉米夫定停止在年轻的年龄呈负相关，与病毒学复发。在终止HBV DNA检测不到，女性，最初HBeAg阴性呈负相关，与生化突破。
结论

患者检测不到病毒滴度拉米夫定停止治疗后病毒学复发和生化突破的发病率很低。生化突破后或病毒学复发再治疗是安全和有效的。间歇性的抗病毒治疗，可能会慎重考虑在适当选择的慢性乙型肝炎患者。

咬牙硬挺

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