在接受10年的核苷类似物治疗乙肝表面抗原水平减少和乙肝表

StephenW

Reduction of hepatitis B surface antigen levels and HBsAg seroclearance in chronic hepatitis B patients receiving 10 years of nucleoside analogue therapy.
Seto WK, Wong DK, Fung J, Huang FY, Lai CL, Yuen MF.
Source

Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong.
Abstract

The profile and clinical significance of serum hepatitis B surface antigen (HBsAg) levels during long-term nucleoside analogue (NA) therapy in chronic hepatitis B (CHB) is undetermined. From 1994 to 2002, 322 Chinese CHB patients were started on lamivudine in our center. Patients were recruited if they were continuously treated with lamivudine for at least 10 years and maintained favorable virologic responses throughout therapy (HBV DNA <2,000 IU/mL). HBsAg and HBV DNA levels were serially measured and the predictability of HBsAg kinetics in determining NA-related HBsAg seroclearance was determined. 70 patients were recruited, of which 43 (61.4%) were hepatitis B e antigen (HBeAg)-positive. 52 (74.3%) had undetectable viremia (HBV DNA <20 IU/mL) during therapy. 15 patients (21.4%) were followed up for 15 years. The median rate of HBsAg reduction was 0.104 log IU/mL/year, with no significant difference found when comparing patients who were HBeAg-positive versus -negative, genotype B versus C, and detectable versus undetectable viremia during therapy (all p>0.05). 7 patients (10%) achieved HBsAg seroclearance, and when compared with the remaining 63 patients, had a significantly lower median baseline HBsAg levels (p=0.012) and a greater median rate of HBsAg reduction (p<0.001). Baseline HBsAg levels and the rate of HBsAg reduction achieved an AUROC of 0.860 (p=0.004, 95% confidence interval 0.742-0.978) and 0.794 (p=0.018, 95% confidence interval 0.608-0.979) respectively. Baseline HBsAg <1,000 IU/mL and on-treatment reduction of HBsAg >0.166 log IU/mL/year were optimal cut-off levels in predicting subsequent HBsAg seroclearance (negative predictive values 98.1% and 97.8% respectively). In conclusion, low baseline HBsAg levels and greater rate of HBsAg reduction achieved high predictive values for predicting HBsAg seroclearance, strengthening the prognostic role of HBsAg measurements during NA therapy. (HEPATOLOGY 2013.).

StephenW

的个人资料及临床意义血清乙肝表面抗原（HBsAg）水平在长期的核苷类似物（NA）治疗慢性乙型肝炎（CHB）是不确定的。从1994年到2002年，322例慢性乙型肝炎患者，开始拉米夫定在我们的中心。患者被招募，如果他们继续用拉米夫定治疗至少10年，并保持了良好的整个治疗的病毒学反应（HBV DNA <2,000 IU /毫升）。 HBsAg和HBV DNA水平进行连续测量，确定NA相关的乙肝表面抗原转阴，乙肝表面抗原动力学的可预见性。招募70例，其中43名（61.4％），乙型肝炎e抗原（HBeAg）阳性。有52（74.3％）检测不到病毒血症（HBV DNA <20 IU / mL）的治疗过程中。随访15例（21.4％）为15岁。 HBsAg的减少率中位数为0.104日志IU /毫升/年，没有显着的差异进行比较时，发现谁是病人HBeAg阳性与阴性，B型与C，并在治疗过程中的检测与检测不到病毒血症（P> 0.05） 。 7例（10％）达到乙肝表面抗原转阴，并与其余63名患者相比，有显着较低的中位数基线HBsAg水平（P = 0.012）和更大的平均HBsAg的减少率（P <0.001）。基线HBsAg水平和乙肝表面抗原减少率达到AUROC为0.860（P = 0.004，95％可信区间为0.742-0.978）和0.794（P = 0.018，95％可信区间为0.608-0.979）。基线HBsAg的<1000 IU / mL和治疗减少对HBsAg> 0.166日志IU /毫升/年最佳截止水平预测随后的乙肝表面抗原转阴（阴性预测值分别为98.1％和97.8％）。总之，低基线HBsAg水平和更大的HBsAg减少率达到了较高的预测值用于预测乙肝表面抗原转阴，加强NA治疗期间HBsAg的测量预后的作用。 （肝病2013）。

咬牙硬挺

感谢分享