[AASLD2015](1558)恩替治疗部分应答患者长期临床结果

StephenW

1558
Long term clinical outcome in chronic hepatitis B patients
with partial virologic response to entecavir treatment
Kyu sik Chung, Hye Won Lee, Jun Yong Park, Hye Jin Ku, Beom
Kyung Kim, Seung Up Kim, Do Young Kim, Kwang-Hyub Han,
Sang Hoon Ahn; Department of Internal Medicine, Yonsei University
College of Medicine, Seoul, Korea (the Republic of)
Background: The aim of this study is to investigate whether
partial virological response (PVR) to entecavir (ETV) treatment
might affect long term clinical outcome including hepatocellular
carcinoma (HCC) and hepatic decompensation occurrence
or not. Methods: Treatment naïve chronic hepatitis B (CHB)
patients treated with ETV (0.5 mg/day) for at least 1 year
were subsequently followed up with regular surveillance of
liver relate events (LRE) occurrence which including HCC occurrence,
hepatic decompensation, liver-related mortality, and
liver transplantation. PVR was defined as a decrease in HBVDNA
titer of more than 1 log10IU/mL, by real time-polymerase
chain reaction, but with residual serum HBV-DNA, at week 48
of ETV therapy. Results: A total of 538 CHB patients (354males
and 184 females) were followed up for median 59.7 months.
At 48 weeks after ETV treatment, complete viral response (CVR,
HBV-DNA<20 IU/mL) was achieved in 392 (72.9%) patients
and PVR in 138 (25.7%) patients. In patients with PVR, CVR
was achieved in 63.8%, and 76.8% at 3- and 5- year after
ETV treatment, respectively. During follow-up, cumulative incidences
of HCC and LRE were comparable with patients with
CVR and those with PVR (P=0.135 and P=0.062, respectively).
In univariate analysis, old age, liver cirrhosis, and non-ALT normalization
at week 48 were related with HCC and LRE occurrence
(all P<0.05), whereas PVR was not significantly related
with HCC and LRE occurrence (both P>0.05). In multivariate
analysis, age and liver cirrhosis were selected as independent
risk factors of LRE occurrence (both P<0.001). In sub-group of
compensated cirrhosis, PVR was also not significantly related
with HCC and LRE occurrence (P=0.805). Conclusions: Patients
with PVR to ETV had favorable virological outcome and comparable
long term clinical outcome comparing those with CVR,
suggesting early rescue therapy for patient with PVR might not
be urgent unless patients are at high risk of hepatic decompensation
and HCC development.

StephenW

1558
在慢性乙肝患者长期临床结果
与部分病毒学应答恩替卡韦治疗
圭植涌，惠元利，君永园区，惠靳库，范
庆金，升最多金，难道扬金，KWANG-Hyub汉，
桑勋安;内科，延世大学系
医学院，韩国首尔（共和国）的
背景：本研究的目的是调查是否
部分病毒学应答（PVR），恩替卡韦（ETV）治疗
可能会影响长期的临床结果包括肝细胞
肝癌（HCC）和肝功能失代偿的发生
或不。方法：对确诊的慢性乙型肝炎（CHB）
恩替卡韦（0.5毫克/天）至少1年治疗的患者
随后随访，定期监测
肝脏相关事件（LRE）发生这其中包括肝癌的发生，
肝功能失代偿，肝有关的死亡率和
肝移植。 PVR被定义为在HBVDNA的降低
滴度超过1 log10IU /毫升，通过实时聚合酶
链反应，但与剩余血​​清HBV-DNA，在48周
的ETV治疗。结果：共538例慢性乙型肝炎患者（354males
和184名女性），随访中位数59.7个月。
在ETV治疗，彻底的病毒反应后48周（CVR，
HBV-DNA <20 IU /毫升）在392（72.9％）的患者获得
和PVR 138（25.7％）的患者。患者的PVR，CVR
在63.8％达到了，并且在3-后76.8％和5年
ETV治疗，分别。在随访期间，累计发生率
肝癌和LRE可比性与患者
CVR和那些与PVR的（P = 0.135和P = 0.062，分别）。
在单因素分析，高龄，肝硬化和非ALT复常
在48周与肝癌和LRE的发生均与
（均P <0.05），而PVR不显著相关
与肝癌和LRE发生（均P> 0.05）。在多元
分析，年龄和肝硬化被选定为独立
LRE发生（均P <0.001）的危险因素。在子组的
代偿性肝硬化，PVR也没有显著相关
与肝癌和LRE发生（P = 0.805）。结论：患者
与PVR教育电视具有良好的病毒学结果和可比性
相比那些CVR长期的临床结果，
这表明早期抢救治疗的患者PVR可能不
紧迫，除非患者是在肝功能失代偿的高危人群
和肝癌发展。

ivanich

给个结论

肝和胆

好难看懂

阳光醉人

文章说明：部分病毒学应答（PVR）的人并没有显著增加患HCC的风险。但耐药呢？