服抗病毒治疗停止后临床疗效, 预测复发。

StephenW

J Gastroenterol. 2015 Dec 19. [Epub ahead of print]
Clinical outcomes and predictors for relapse after cessation of oral antiviral treatment in chronic hepatitis B patients.Jung KS1, Park JY1,2,3, Chon YE1, Kim HS4, Kang W1, Kim BK1,2,3, Kim SU1,2,3, Kim DY1,2,3, Han KH1,2,3,5, Ahn SH6,7,8,9.
Author information

• 1Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
• 2Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
• 3Liver Cirrhosis Clinical Research Center, Seoul, Korea.
• 4Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
• 5Brain Korea 21 Project of Medical Science, Seoul, Korea.
• 6Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. [email protected].
• 7Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. [email protected].
• 8Liver Cirrhosis Clinical Research Center, Seoul, Korea. [email protected].
• 9Brain Korea 21 Project of Medical Science, Seoul, Korea. [email protected].
  

AbstractBACKGROUND: Little is known about stopping rules of nucelos(t)ide analog (NA) treatment for chronic hepatitis B (CHB).
METHODS: A total of 113 consecutive patients with CHB (45 HBeAg-positive and 68 HBeAg-negative CHB patients), who met the cessation criteria of NA treatment as per the Asian-Pacific Association for the Study of the Liver (APASL) guideline, were enrolled in this prospective cohort study. The primary endpoint was to evaluate virological relapse (VR) rate within 1 year, which was defined as reappearance of hepatitis B virus (HBV)-DNA > 2000 IU/mL after cessation of NA treatment. In this cohort, entecavir was used in 81 (71.7 %) and lamivudine in 32 (28.3 %) patients.
RESULTS: Within 1 year after NA treatment, VR occurred in 26 (57.8 %) HBeAg-positive patients and in 37 (54.4 %) HBeAg-negative patients. In univariate and subsequent multivariate analysis, age > 40 years [odds ratio (OR) 10.959; 95 % confidence interval (CI) 2.211-54.320; P = 0.003) and a pre-treatment HBV DNA level >2000,000 IU/mL (OR 9.285; 95 % CI 1.545-55.795; P = 0.036) were identified as independent risk factors for VR in HBeAg-positive patients, and age > 40 years (OR 6.690; 95 % CI 1.314-34.057; P = 0.022) and an end-of-treatment HBcrAg level >3.7 log IU/mL (OR 3.751; 95 % CI 1.187-11.856; P = 0.024) were identified in HBeAg-negative patients. During follow up, neither hepatic decompensation nor hepatocellular carcinoma (HCC) occurred, and HBV DNA suppression was achieved in all patients who received antiviral re-treatment.
CONCLUSION: Our data suggested that the APASL stopping rule could be applied if a candidate was properly selected using individual risk factors. However, regular monitoring should be performed after cessation of NA treatment and long-term outcomes need to be evaluated further.


KEYWORDS: Antiviral treatment; Chronic hepatitis B; Durability; Nucleos(t)ide analogue; Relapse

StephenW

ĴGastroenterol。 2015年19月[EPUB提前打印]
临床结果和预测戒烟的慢性乙肝患者口服抗病毒治疗后复发。
荣格KS1，公园JY1,2,3，川川YE1，金HS4，康W1，金BK1,2,3，金SU1,2,3，金DY1,2,3，韩KH1,2,3,5，安贞焕SH6,7,8,9。
作者信息

    教研室内科，医学延世大学，延世50-1-RO，西大门区，首尔，120-752，韩国。
    2中国科学院消化，医药，韩国首尔延世大学。
    3Liver肝硬化临床研究中心，韩国首尔。
    4Department检验医学，医学延世大学，首尔，韩国。
    5Brain韩国21项目医学科学，首尔，韩国。
    6Department内科，医学延世大学，延世50-1-RO，西大门区，首尔，120-752，韩国。 [email protected]。
    7Institute消化，医药，韩国首尔延世大学。 [email protected]。
    8Liver肝硬化临床研究中心，韩国首尔。 [email protected]。
    9Brain韩国21项目医学科学，首尔，韩国。 [email protected]。

抽象
背景：

鲜为人知的是，停止nucelos（t）的IDE模拟（NA）处理规则慢性乙型肝炎（CHB）。
方法：

连续入选113例慢性乙型肝炎（45 HBeAg阳性和68例HBeAg阴性慢性乙肝患者），谁见了NA治疗停止的标准为每亚太协会肝（APASL）准则的研究，被纳入本前瞻性队列研究。主要终点是评价病毒学复发（VR）率1年内，其被定义为B型肝炎病毒的再现（HBV）-DNA> 2000 IU / mL的NA停止治疗后。在这个队列中，恩替卡韦被用在81（71.7％）和拉米夫定32（28.3％）的患者。
结果：

1年NA处理后的，VR发生在26（57.8％），HBeAg阳性患者和37（54.4％），HBeAg阴性患者。在单因素和多因素以后的分析中，年龄> 40岁[比值比（OR）10.959; 95％置信区间（CI）2.211-54.320; P = 0.003）和治疗前HBV DNA水平> 2,000,000 IU /毫升（或9.285; 95％CI为1.545-55.795; P = 0.036）被确定为独立危险因素VR在HBeAg阳性患者和年龄> 40岁（OR 6.690; 95％CI为1.314-34.057; P = 0.022），治疗结束和一个HBcrAg水平> 3.7日志国际单位/毫升（OR 3.751; 95％CI为1.187-11.856; P = 0.024）被确定在HBeAg阴性患者。在随访期间，无论是肝功能失代偿，也不肝细胞癌（HCC）的发生和HBV DNA抑制是在谁接受了抗病毒再治疗所有患者实现。
结论：

我们的数据表明，如果候选人是使用独立危险因素选择适当的APASL停止规则可以适用。需要进一步评估然而，定期监测应停止NA治疗和长期结果后进行。
关键词：

抗病毒治疗;慢性乙型肝炎;耐久性;核苷（酸）类似物IDE;复发