停止治疗HBeAg阴性疾病

StephenW

Stopping Therapy in HBeAg Negative Disease

    Weng Kai Chan,
    Soek-Siam Tan,
    Rosmawati Mohamed


Abstract

Chronic hepatitis B infection confers a major risk of cirrhosis and hepatocellular carcinoma worldwide. The ultimate long-term goal of chronic hepatitis B therapy is to reduce morbidity and mortality related to liver disease progression. The ideal treatment endpoint is HBsAg seroconversion. As HBsAg clearance is rarely achieved, the short-term goal of therapy is maintained suppression of hepatitis B replication. For HBeAg-positive patients, durable HBeAg seroconversion with undetectable HBVDNA is a satisfactory intermediate end-point. For HBeAg-negative patients, the treatment endpoint remains unclear, hence, sustained suppression of HBV DNA level to low or undetectable levels is the optimal treatment response. Several studies in HBeAg-negative population have proposed that discontinuation of antiviral treatment can be considered if undetectable serum HBV DNA is demonstrated on three separate occasions at least 6 months apart. Preliminary data suggests that on-treatment HBsAg quantification may play a role as a predictor of sustained response off-therapy.

StephenW

慢性B型肝炎感染赋予肝硬化和肝细胞癌全球的主要风险。慢性乙型肝炎治疗的长期目标是最终降低发病率和死亡率相关的肝脏疾病的进展。理想的治疗终点是HBsAg血清学转换。由于HBsAg清除很少能达到治疗的目的，短期保持抑制乙肝复制。对于HBeAg阳性患者HBVDNA检测不到的，持久的HBeAg血清转换是一个满意的中间终点。对于HBeAg阴性患者，治疗终点仍不清楚，因此，持续抑制HBV DNA水平低或检测不到的水平，是最佳的治疗反应。 HBeAg阴性人群中的一些研究提出停止抗病毒治疗血清HBV DNA检测不到，可以考虑，如果是表现在三个不同场合至少6个月。初步数据表明，对治疗乙肝表面抗原定量可能作为预测持续应答的治疗中发挥作用。

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