AASLD2014:乙肝表面抗原定量的预测作用核苷停药后HBV再激活（T

StephenW

1876
The role of hepatitis B surface antigen quantification predict HBV reactivation after discontinuation of nucleos(t)ide analogs treatment in chronic hepatitis B patients with cirrhosis
Chien-Hung Chen, Chuan-Mo Lee, Tsung-Hui Hu, Chao-Hung Hung, JIng-Houng Wang, Sheng-Nan Lu;
Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan

Background and Aims:This study investigated the incidence of hepatitis B virus (HBV) reactivation and role of quantification of HBsAg (qHBsAg) levels in HBV reactivation after stopping nucleos(t)ide analogs (NA) treatment in chronic hepatitis B (CHB) patients with cirrhosis.
Patients and Methods: From 2004 to 2012, a total of 85 CHB patients with cirrhosis (20 HBeAg-positive, 65 HBeAg-negative at baseline) received NAs treatment (50 lamivudine, 30 entecavir, 5 telbivudine) (treatment duration: mean ± SD: 128±60.1 weeks, range: 78-409 weeks) and have stopped the treatment at least 12 months were recruited. The criteria of stopping NAs therapy met the recommendations of APASL 2012. HBV reactivation is defined as serum HBV DNA level > 2000 IU/mL after stopping NAs treatment. Serum qHBsAg levels were determined at baseline, month 12 of treatment and at the end of treatment. Results: Of the 85 CHB patients with cirrhosis, the cumulative rates of HBV reactivation at months 12, 24 and 36 were 48.2%, 57%, and 65.8% respectively after stopping NAs treatment. Cox regression analysis showed that only qHBsAg at the end of treatment [increased per one year; hazard ratio (HR):2.15, 95% confidence interval (CI): 1.50-3.09] was an independent predict for HBV reactivation. Time-dependent receiver-operating characteristic (ROC) curve analysis showed that the best cut-off value for predicting HBV reactivation within 3 years after cessation of NAs treatment was 388.6 IU/mL (area under the ROC curve: 0.804). We used HBsAg of 350 IU/mL as a marker to predict HBV reactivation (p < 0.001). Of the patients who had qHBsAg levels of ≤ 350 and > 350 IU/mL at the end of treatment, the cumulative rates of HBV reactivation at month 36 were 28.9% and 90.2% respectively. Fourteen of 85 cirrhotic patients experienced HBsAg loss during follow-up period. Of the 54 patients who experienced HBV reactivation, 45 had clinical relapse (ALT>80 IU/L) during follow-up. Of them, 9 experienced hepatic decompensation (total bilirubin >3 mg/dL). Of the 9 patients with hepatic decompensation, 1 expired although antiviral agent was used. Of the 14 patients who experienced HBsAg loss, 4 developed hepatocellular carcinoma (HCC) after HBsAg loss.
Conclusions: Serum qHBsAg level was a useful predictor for HBV activation after stopping NAs treatment in CHB patients with cirrhosis. Hepatitis relapse with hepatic decompensation was still an important issue after cessation of NAs therapy in cirrhotic patients. HBsAg loss after cessation of NAs treatment did not completely eliminate the risk of HCC in cirrhotic patient, and such patients should be continuously monitored for HCC.

Disclosures:

The following people have nothing to disclose: Chien-Hung Chen, Chuan-Mo Lee, Tsung-Hui Hu, Chao-Hung Hung, JIng-Houng Wang, Sheng-Nan Lu

StephenW

1876
乙肝表面抗原定量的预测作用核苷停药后HBV再激活（T）类似物治疗慢性乙型肝炎肝硬化患者
陈建宏，川钼李琮辉胡肇鸿鸿，王景弘，卢胜男;
长庚纪念医院，高雄医学中心，台湾高雄

背景和目的：本研究探讨乙型肝炎病毒（HBV）再激活和乙肝表面抗原（qHBsAg）的量化作用，乙肝病毒再激活水平的发病率在慢性乙型肝炎（CHB）患者停止核苷（酸）类似物（NA）治疗后肝硬化。
病人与方法：从2004年到2012年，总共有85乙型肝炎肝硬化患者（20例HBeAg阳性，65例HBeAg阴性基线）接受治疗佐（50拉米夫定，恩替卡韦30，5替比夫定）（处理时间：平均值±标准差：128±60.1周，范围：78-409周），并停止至少12个月被招募的治疗。停止新来港治疗的标准，满足APASL2012年乙肝病毒再激活被定义为血清HBV DNA水平>2000 IU/ mL的网路设备停止治疗后的建议。血清qHBsAg水平基线，治疗12个月，并在治疗结束时确定。结果：85例慢性乙型肝炎患者有肝硬化，乙肝病毒再激活的12个月，24和36的累积率分别为48.2％，57％和65.8％，港定居停止治疗后。 Cox回归分析显示，只有qHBsAg在治疗[每逐年上升的结束;风险比（HR）：2.15，95％可信区间（CI）：1.50-3.09]是一个独立的预测为HBV再激活。随时间变化的受试者工作特征（ROC）曲线分析表明，预测HBV再激活停止来港定居的治疗后3年内的最佳临界值是388.6 IU/毫升（ROC曲线下面积：0.804）。我们使用350国际单位/毫升乙肝表面抗原作为标记来预测HBV再激活（P <0.001）。谁具有≤350 qHBsAg水平和> 350国际单位/毫升，在治疗结束时的患者中，HBV激活的在36个月的累积率分别为28.9％和90.2％。 85例肝硬化患者的经历十四个在随访期间HBsAg消失。谁经历过HBV再激活的54例患者中，45例临床复发（ALT>80 IU / L），在随访期间。其中，9个经验丰富的肝功能失代偿（总胆红素>3毫克/分升）。 9例肝功能失代偿，1过期尽管抗病毒药剂使用。谁经历HBsAg消失的14例患者中，4个研发肝细胞癌（HCC）HBsAg消失后。
结论：血清qHBsAg水平与肝硬化停港定居治疗慢性乙型肝炎患者后的HBV激活一个有用的指标。肝炎复发与肝功能失代偿仍停止佐治疗肝硬化患者后，一个重要的问题。戒烟佐治疗后HBsAg消失并没有完全消除HCC的肝硬化患者的风险，而这种患者应肝癌进行连续监测。

披露：

下面的人都没有透露：陈建宏，川钼李琮辉胡肇鸿鸿，王景弘，卢胜男