血清HBV DNA和HBsAg水平预测拉米夫定治疗病毒突破

StephenW

Clinical Hepatology
血清HBV DNA和HBsAg水平预测的不同作用
在接受拉米夫定治疗的患者病毒学突破

Differential roles of serum HBV DNA and HBsAg level in predicting
virological breakthrough in patients receiving lamivudine therapy

Chien-Wei Su1,2,3,†,
Chun-Ying Wu2,4,5,6,†,
Hung-Hsu Hung2,3,7,
Chu-Hui Wu8,
I-Jane Sheen3,
Jaw-Ching Wu3,*
DOI: 10.1111/jgh.12283

Abstract

Background and aim

The role of serum hepatitis B surface antigen (HBsAg) level in determining
virological breakthrough (VB) for patients with hepatitis B virus (HBV)
infection receiving lamivudine remains unclear. We aimed to evaluate the
impact of serum HBsAg levels on VB among patients receiving lamivudine
therapy, especially in a setting of low HBV viral load.

Methods

We enrolled 268 consecutive treatment-naïve patients who underwent
lamivudine therapy for chronic hepatitis B (CHB). Factors in terms of VB
were analyzed by multivariate analysis.

Results

After a median treatment duration of 67.1 weeks, 102 patients had VB.
Multivariate analysis showed that positive hepatitis B e antigen (HBeAg)
(Hazard ratio, HR 2.179, p=0.012) and HBV DNA levels ≥2000 IU/mL after 6
months of lamivudine therapy (HR 5.460, p<0.001) were independent risk
factors predicting VB. The cumulative VB rates stratified by HBeAg positive
and negative at 3 years were 44.7% and 26.3%, respectively. At 3 years,
the cumulative VB rates stratified by the HBV DNA <2000 and ≥2000 IU/mL
after 6 months of therapy were 25.5% and 79.4%, respectively. For
HBeAg-positive patients with serum HBV DNA <2000 IU/mL after 6 months of
therapy, baseline HBsAg levels ≥20000 IU/mL was the only risk factor
associated with VB.

Conclusions

For CHB patients treated with lamivudine, serum HBV DNA level>2000 IU/mL
after 6 months of therapy could predict subsequent VB. In patients with
lower on-treatment viral load, baseline serum HBsAg level is associated
with the emergence of VB, especially for those with serum positive HBeAg.

StephenW

背景和目的

血清乙型肝炎表面抗原（HBsAg）在确定水平的作用
病毒学突破（VB）的患者与乙肝病毒（HBV）
感染接受拉米夫定仍不清楚。我们的目的是评估
接受拉米夫定的患者血清HBsAg水平VB的影响
治疗，特别是在低HBV病毒载量的设定。

方法

我们连续招收268谁接受治疗初治患者
拉米夫定治疗慢性乙型肝炎（CHB）。 VB方面因素
分析多因素分析。

结果

在平均治疗时间为67.1周，102例患者有VB。
多因素分析显示阳性乙肝e抗原（HBeAg）
（危险比HR2.179，P = 0.012）和HBV DNA水平≥2000 IU/ mL的后6
拉米夫定治疗个月（HR =5.460，P <0.001）的独立危险
VB的预测因素。 HBeAg阳性分层累计VB率
负3年分别为44.7％和26.3％，分别为。 3年来，
HBV DNA<2000≥2000 IU / mL的分层累计VB率
治疗6个月后分别为25.5％和79.4％，分别。为
HBeAg阳性患者的血清HBV DNA<2000 IU/毫升，6个月后
治疗，基线HBsAg水平≥20000 IU/ mL的唯一的风险因素
与VB。

结论

对于治疗慢性乙型肝炎患者拉米夫定，血清HBV DNA水平>2000 IU/毫升
治疗6个月后可以预测随后VB。患者
治疗降低病毒载量，基线血清HBsAg水平相关
VB的出现，特别是对那些与血清HBeAg阳性。