年龄与HBsAg水平预测NA诱导HBeAg血清转换的耐用性

StephenW

Age and HBsAg level predict NA-induced HBeAg seroconversion durability
Published on January 28, 2015 at 5:15 PM · No

By Lucy Piper, Senior medwireNews Reporter

The combination of age and baseline hepatitis B s-antigen (HBsAg) level can help predict hepatitis B virus (HBV) relapse in patients who achieve hepatitis B e-antigen (HBeAg) loss or seroconversion following nucleos(t)ide analogue (NA) treatment, researchers report.

They found that being 40 years of age or older and having baseline HBsAg levels of 2000 IU/mL or above both significantly and independently predicted HBV relapse during up to 5 years of treatment.

And having both factors predicted the highest rates of relapse, increasing the risk 13.49-fold compared with patients meeting neither of the criteria. Patients with both risk factors were additionally a significant 2.22-fold more likely to relapse than patients who were aged 40 years or older but had HBsAg levels below 2000 IU/mL.
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“These findings indicate that an older age (≥40 years) may be typical of a poor immune response in terms of HBV DNA suppression in patients with NA-induced or spontaneous HBeAg seroconversion”, the team writes in the Journal of Gastroenterology and Hepatology.

The 157 study participants, who were previously NA-naïve and had no signs of cirrhosis or hepatocellular carcinoma, were treated with lamivudine, entecavir or telbivudine. All achieved HBeAg loss or seroconversion and treatment was stopped when undetectable HBV DNA levels were documented on two separate occasions at least 12 months apart.

Eighty-two of the patients relapsed over the 5-year post-treatment follow-up. The mean time to HBV relapse after NA cessation was 13.9 months and 69.5% of patients relapsed in the year after stopping NA treatment.

The rate of relapse at 5 years was significantly higher among patients aged at least 40 years than among those younger than 30 years old and those aged 30 to 39 years, at 84% versus 34.4% and 48.4%, respectively.

Also, based on baseline HBsAg levels, cumulative relapse rates at 4 years were significantly higher for those with levels of at least 2000 IU/mL, at 62.8% compared with 33.7% for those with lower levels.

Researcher Chien-Hung Chen (Kaohsiung Chang Gung Memorial Hospital, Taiwan) and colleagues caution against stopping NA treatment in patients with these risk factors, however, having found that “approximately 90% of such patients experienced a post-treatment HBV relapse within 3 years off-treatment.” Rather, they recommend closely monitoring HBV relapse after NA cessation in these patients.

Despite previous evidence showing that prolonged consolidation therapy of more than 18 or 24 months protects against HBV relapse, there was no evidence of this in the current study. And there was no significant difference in post-treatment HBV relapse rates between patients taking entecavir and those taking lamivudine.

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StephenW

年龄与HBsAg水平预测NA诱导HBeAg血清转换的耐用性
发表于2015年1月28日在5:15 PM·无

由露西·派珀，高级medwireNews记者

年龄和基线乙肝表面抗原的结合（乙肝表面抗原）水平可以帮助预测乙型肝炎病毒（HBV）复发谁实现乙型肝炎e抗原（HBeAg）阳性转阴或血清转化以下核苷（酸）类似物IDE例（NA）治疗，研究人员报告。

他们发现，2000 IU/ mL或以上均为40岁以上的老年人和有基线HBsAg水平在长达5年的治疗显著和独立预测HBV复发。

并有两个因素预测复发率最高，增加了风险13.49倍，患者既不满足的标准进行比较。患者既危险因素是另外一个显著2.22倍更容易复发比谁是40岁以上的老年人，但有HBsAg水平低于2000 IU/ mL的患者。
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“这些发现表明，年龄较大（≥40岁）可能是典型的用NA诱发或自发的HBeAg血清转换中HBV DNA抑制方面的不良免疫反应的病人”，球队中写道胃肠病学和肝病学杂志。

157研究参与者，谁是以前NA-幼稚和有肝硬化或肝癌的迹象，分别用拉米夫定，恩替卡韦或替比夫定。全部实现HBeAg转阴或血清转换和处理，当检测不到HBV DNA水平记录在两个不同场合至少12个月外停止。

八十二的复发在5年的治疗后随访的患者。的平均时间，以NA停止后的HBV复发为13.9个月，患者停止NA治疗后复发的一年69.5％。

复发的5年率为岁之间的比那些年龄超过30岁的年龄在30岁至39岁之间的至少40岁的患者显著较高，为84％和34.4％和48.4％。

此外，基于基线HBsAg水平，对那些具有较低水平的33.7％相比，累积的复发率，在4年是显著高于那些具有至少2000国际单位/毫升的水平，在62.8％。

研究员简洪辰（高雄长庚医院，台湾）和他的同事告诫但停止治疗NA患者的这些危险因素，已经发现，“这样的患者大约90％经历了3年之内后处理HBV复发关闭处理。“相反，他们建议NA停止在这些患者经过严密监控乙肝复发。

尽管以前的证据显示，超过18或24个月长期巩固治疗，可以防止复发的乙肝病毒，但在目前的研究中没有证据证明这一点。并有服用恩替卡韦的患者和那些服用拉米夫定之间在治疗后HBV的复发率无差异显著。

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