在停止慢性乙型肝炎患者拉米夫定或替比夫定治疗后10年随访

StephenW

Clin Microbiol Infect. 2015 Aug 4. pii: S1198-743X(15)00784-3. doi: 10.1016/j.cmi.2015.07.023. [Epub ahead of print]
10-years follow-up of hepatitis B relapse after cessation of lamivudine or telbivudine treatment in chronic hepatitis B patients.Pan HY1, Pan HY2, Chen L3, Yang DH4, Huang HJ5, Tong YX6, Chen CR7, Yan J8.
Author information

• 1Department of Infectious Diseases, Zhejiang Provincial People's Hospital, University of Zhejiang Chinese Medicine, Hangzhou, Zhejiang, China. Electronic address: [email protected].
• 2Department of Medicine, Pujiang People's Hospital, Zhejiang, China. Electronic address: [email protected].
• 3Zhejiang Chinese Medicinal University, Hangzhou, Zhejiang, China. Electronic address: [email protected].
• 4Department of Infectious Diseases, Zhejiang Provincial People's Hospital, University of Zhejiang Chinese Medicine, Hangzhou, Zhejiang, China. Electronic address: [email protected].
• 5Department of Infectious Diseases, Zhejiang Provincial People's Hospital, University of Zhejiang Chinese Medicine, Hangzhou, Zhejiang, China. Electronic address: [email protected].
• 6Department of Infectious Diseases, Zhejiang Provincial People's Hospital, University of Zhejiang Chinese Medicine, Hangzhou, Zhejiang, China. Electronic address: [email protected].
• 7Department of Internal Medicine, Hangzhou XiXi hospital, Hangzhou, Zhejiang, China. Electronic address: [email protected].
• 8Department of Internal Medicine, Hangzhou XiXi hospital, Hangzhou, Zhejiang, China. Electronic address: [email protected].
  

AbstractBACKGROUND & AIMS: The high rate of relapse after cessation of nucleos(t)ide analogues (NUCs) treatment in chronic hepatitis B (CHB) patients leads us to re-assess the feasibility for off-therapy, but long-term follow-up data are scarce. We assessed the feasibility for off-therapy by a long-term observation of relapse in response to lamivudine (LAM) and telbivudine (LdT).
METHODS: 86 NUCs-naïve CHB patients, treated with LAM (n=46) or LdT (n=40) who reached the guidelines recommended for off-therapy were followed for up to 10-years. Hepatitis B virus (HBV), viral serology and biochemistries were periodically determined. COX model was used to predict the risk of relapse.
RESULTS: 52.3% of patients relapsed within a median of 115-months (61-122). 93.3% of relapses occurred within 48-months. Relapse rates in HBeAg-positive (n=56) and HBeAg-negative (n=30) patients were 39.3% and 72.9%, respectively (P<0.01). HBeAg-positive patients who achieved an early viral response (EVR), defined as undetectable HBV-DNA within 6-months, had a lower relapse rate compared to non-EVR patients (21.4% versus 59.2%, P<0.01). EVR patients had both lower HBV-DNA (<106copies/mL) at baseline and lower HBsAg at end of treatment had a relapse rate of 10.7%.
CONCLUSIONS: The high relapse rates in CHB patients over this 10-years follow-up make LAM or LdT off-therapy infeasible in most of the cases, except in the case of HBsAg loss and/or seroconversion. HBeAg-positive patients with EVR, lower HBV-DNA, HBsAg had lower relapse rates and could be good candidates for off-therapy. Long-term monitoring, especially during the first 4 years, is critical for off-therapy patients.
Copyright © 2015. Published by Elsevier Ltd.


KEYWORDS: chronic; durability; hepatitis B; long-term; nucleoside analogues

StephenW

临床微生物传染。 2015年4月PII：S1198-743X（15）00784-3。 DOI：10.1016 / j.cmi.2015.07.023。 [打印EPUB的提前]
在停止慢性乙型肝炎患者拉米夫定或替比夫定治疗后10年随访的乙肝复发。
潘HY1，HY2潘，陈L3，杨DH4，黄HJ5，佟YX​​6，陈CR7，严J8。
作者信息

    传染病教研室，浙江省人民医院，浙江中医药中国，杭州，浙江，中国的大学。电子地址：[email protected]。
    医学教研室，浦江县人民医院，浙江，中国的。电子地址：[email protected]。
    3Zhejiang中国药科大学，杭州，浙江，中国。电子地址：[email protected]。
    传染病4Department，浙江省人民医院，浙江中医药中国，杭州，浙江，中国的大学。电子地址：[email protected]。
    传染病5Department，浙江省人民医院，浙江中医药中国，杭州，浙江，中国的大学。电子地址：[email protected]。
    传染病6Department，浙江省人民医院，浙江中医药中国，杭州，浙江，中国的大学。电子地址：[email protected]。
    7Department内科，杭州西溪医院，杭州，浙江，中国的。电子地址：[email protected]。
    8Department内科，杭州西溪医院，杭州，浙江，中国的。电子地址：[email protected]。

抽象
背景与目的：

高复发率戒烟核苷后慢性乙型肝炎（）类似物（NUCs）处理（CHB）患者引导我们重新评估场外治疗的可行性，但长期随访数据很少。我们评估了截止治疗的可行性通过长期观察复发响应于拉米夫定（LAM）和替比夫定（LDT）。
方法：

86 NUCs初治慢性乙肝患者，LAM（N = 46）或LDT（N = 40），谁达到建议场外治疗准则随后长达10年的处理。乙型肝炎病毒（HBV），病毒血清学和生化指标进行周期性地确定。 COX模型被用来预测复发的风险。
结果：

患者52.3％的115个月（61-122）中位数内复发。复发93.3％发生48个月内。在HBeAg阳性（N = 56）和HBeAg阴性（N = 30）的患者复发率分别为39.3％和72.9％（P <0.01）。谁取得了早期病毒应答（EVR）HBeAg阳性患者，6个月内被定义为不可检测HBV-DNA，有一个较低的复发率相比，非EVR的患者（21.4％对59.2％，P <0.01）。 EVR的患者在基线有两个下HBV-DNA（<106copies / mL）和较低的HBsAg在治疗结束了10.7％复发率。
结论：

高复发率的慢性乙肝患者在这个10年的随访化妆LAM或LDT场外治疗不可行，在大多数的情况下，除了在HBsAg消失和/或血清转换的情况下。 HBeAg阳性患者的EVR，降低HBV-DNA，乙肝表面抗原具有较低的复发率，可能是很好的人选离治疗。长期监测，尤其是在头4年，是为关断治疗患者的关键。

版权所有©2015年出版公司爱思唯尔
关键词：

慢性;耐用性;乙型肝炎;长期;核苷类似物

老折腾

建议出国的大神把关键内容译一下，看得费劲

齐欢畅2

CONCLUSIONS: The high relapse rates in CHB patients over this 10-years follow-up make LAM or LdT off-therapy infeasible in most of the cases, except in the case of HBsAg loss and/or seroconversion. HBeAg-positive patients with EVR, lower HBV-DNA, HBsAg had lower relapse rates and could be good candidates for off-therapy. Long-term monitoring, especially during the first 4 years, is critical for off-therapy patients.

disan

齐欢畅2 发表于 2015-8-10 21:39
CONCLUSIONS: The high relapse rates in CHB patients over this 10-years follow-up make LAM or LdT off ...

这个结论和德可关于ARC520的猜想一致。看来eAg+应该可以用520联合治疗了。
eAg+总体比例多少？10%?

齐欢畅2

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大三阳比小三阳好治疗？

jiankangren19

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