HBsAg和HBV DNA水平在中国慢性乙肝患者的变化经过五年的恩替

StephenW

J Gastroenterol Hepatol. 2013 Dec 10. doi: 10.1111/jgh.12476. [Epub ahead of print]
Changes of HBsAg and HBV DNA levels in Chinese chronic hepatitis B patients after five years of entecavir treatment.Seto WK, Lam YF, Fung J, Wong DK, Huang FY, Hung IF, Lai CL, Yuen MF.
Author information  

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

AbstractBACKGROUND: Hepatitis B surface antigen (HBsAg) kinetics during long-term entecavir therapy has not been well investigated.
METHODS: We described the cumulative serologic, virologic and biochemical outcomes and the occurrence of signature entecavir mutations among 222 Chinese treatment-naïve chronic hepatitis B (CHB) patient receiving entecavir for up to 5 years.
RESULTS: The median rate of HBsAg reduction over 5 years was 0.125 log IU/mL/year. Patients with high baseline HBV DNA levels (≥8 log copies/mL or ≥7.3 log IU/mL), when compared those with baseline HBV DNA <7.3 log IU/mL, had a significantly greater median rate of HBsAg reduction (0.178 and 0.102 log IU/mL/year respectively, p<0.001). The difference in HBsAg decline was most prominent in the first year (0.324 and 0.062 log IU/mL/year respectively, p<0.001). Greater median rates of HBsAg reduction were also found in hepatitis B e antigen (HBeAg)-positive patients when compared to HBeAg-negative patients (0.144 and 0.098 log IU/mL/year, p=0.015), and in patients with high baseline HBsAg levels (≥3 log IU/mL), when compared with patients with low baseline HBsAg <3 log IU/mL (0.131 and 0.045 log IU/mL/year respectively, p=0.001). The 5-year cumulative rate of HBV DNA undetectability (<20 IU/mL) was 97.1%. There were two cases of entecavir resistance, resulting in a 5-year cumulative resistance rate of 1.2%.
CONCLUSION: In contrast to the profound HBV DNA suppression, long-term entecavir treatment only achieve slow decline in serum HBsAg. Although certain patient subgroups exhibit a more rapid HBsAg reduction, additional therapeutic agents are needed to increase the chance of HBsAg seroclearance in CHB.

StephenW

胃肠病学肝脏病。 2013 12月10日。 DOI ： 10.1111/jgh.12476 。 [检索策略]
HBsAg和HBV DNA水平在中国慢性乙肝患者的变化经过五年的恩替卡韦治疗。
濑户WK ，林YF ，凤Ĵ ，黄DK ，黄财年，洪中频，赖发光，袁MF 。
作者信息

    香港香港大学医学系，玛丽医院， 。

摘要
背景：

在长期的恩替卡韦治疗乙型肝炎表面抗原（HBsAg ）动力学没有得到很好的研究。
方法：

我们所描述的累积血清学，病毒学和生化结果和签名恩替卡韦突变之间222中国治疗初治的慢性乙型肝炎（CHB ）患者接受恩替卡韦长达5年的发生。
结果：

乙肝表面抗原减少超过5年的平均率为0.125登录国际单位/毫升/年。患者高基线HBV DNA水平（ ≥ 8日志拷贝/ ml或≥ 7.3登录国际单位/毫升） ，相比那些与基线HBV DNA < 7.3日志IU / mL时，有乙肝表面抗原减少的显著更大的平均速率（ 0.178和0.102分别登录国际单位/毫升/年， P <0.001） 。在HBsAg的下降差异最显着的第一年（分别为0.324和0.062登录国际单位/毫升/年， P <0.001） 。中也发现了B型肝炎e抗原HBsAg的减少大于中位数速率（ e抗原）阳性的患者相比， HBeAg阴性患者（ 0.144和0.098登录国际单位/毫升/年， P = 0.015） ，而高的患者基线HBsAg的水平（ ≥ 3登录国际单位/毫升） ，与患者的低基线HBsAg的比较< 3登录国际单位/毫升（ 0.131和0.045分别登录国际单位/毫升/年， P = 0.001） 。 HBV DNA不可检测（ < 20国际单位/毫升）的5年累积发生率为97.1 ％ 。有2例恩替卡韦耐药性，导致1.2％的5年累计耐药率。
结论：

与此相反的深刻的HBV DNA抑制，长期恩替卡韦治疗只能达到缓慢下降，血清HBsAg 。虽然某些患者亚组表现出更快速的HBsAg下降，需要额外的治疗剂来提高HBsAg清除的慢性乙型肝炎的机会。