慢性乙型肝炎长期恩替卡韦治疗期间爆发

StephenW

J Gastroenterol Hepatol. 2016 Mar 24. doi: 10.1111/jgh.13377. [Epub ahead of print]
Flares during long-term entecavir therapy in chronic hepatitis B.Chi H1, Arends P1, Reijnders JG1, Carey I2, Brown A3, Fasano M4, Mutimer D5, Deterding K6, Oo YH5, Petersen J7, van Bommel F8, de Knegt RJ1, Santantonio TA4, Berg T8, Welzel TM9, Wedemeyer H6, Buti M10, Pradat P11, Zoulim F11, Hansen B1, Janssen HL1,12; VIRGIL Surveillance Study Group (European surveillance network for vigilance against viral resistance).
Author information

• 1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
• 2Department of Hepatology and Gastroenterology, King's College London, London, United Kingdom.
• 3Department of Hepatology and Gastroenterology, Imperial College London, London, United Kingdom.
• 4Clinic of Infectious Diseases, University of Foggia, Foggia, Italy.
• 5Centre for Liver Research, NIHR Biomedical Research Unit in Liver Disease, University of Birmingham & Queen Elizabeth Hospital, Birmingham, United Kingdom.
• 6Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany.
• 7Ifi Institute, Asklepios Klinik St. Georg, Hamburg, Germany.
• 8Department of Hepatology, University Clinic Leipzig, Leipzig, Germany.
• 9Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany.
• 10Department of Hepatology, Hospital Vall de Hebron, Barcelona, Spain.
• 11Department of Hepatology, Hôpital de la Croix-Rousse Hospices Civils de Lyon, Lyon, France.
• 12Toronto Centre for Liver Disease, University Health Network, Toronto, Canada.
  

AbstractBACKGROUND AND AIM: The incidence and consequences of flares during first-line nucleos(t)ide analogue therapy are largely unknown. We aimed to investigate the incidence and outcome of ALT flares during long-term entecavir (ETV) in chronic hepatitis B (CHB).
METHODS: CHB patients treated with ETV monotherapy from 11 European centers were studied. Flare was defined as >3x increase in ALT compared with baseline or lowest on-treatment level, and an absolute ALT >3x upper limit of normal. Flares were designated as host-induced (preceded by HBV DNA decline), virus-induced (HBV DNA increase), or indeterminate (stable HBV DNA).
RESULTS: 729 patients were treated with ETV for median of 3.5 years. Thirty patients developed a flare with cumulative incidence of 6.3% at year 5. Baseline HBeAg-positivity (HR 2.84; p = 0.005) and high HBV DNA (HR 1.30; p = 0.003) predicted flares. There were 12 (40%) host-induced, 7 (23%) virus-induced, and 11 (37%) indeterminate flares. Host-induced flares occurred earlier than virus-induced (median: 15 vs. 83 weeks; p = 0.027) or indeterminate flares (15 vs. 109 weeks; p = 0.011). Host-induced flares were associated with biochemical remission, and HBeAg (n = 3) and HBsAg (n = 2) seroconversions were exclusively observed among patients with these flares. Virus-induced flares were associated with ETV resistance (n = 2) and non-compliance (n = 1).
CONCLUSION: The incidence of ALT flares during ETV was low in this real-life cohort. ETV can be safely continued in patients with host-induced flares. Treatment adherence and drug resistance must be assessed in patients with virus-induced flares. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.


KEYWORDS: ALT; chronic hepatitis B; entecavir; flare; nucleos(t)ide analogue

StephenW

ĴGastroenterol肝脏病。 2016年24月DOI：10.1111 / jgh.13377。 [打印EPUB提前]
慢性乙型肝炎长期恩替卡韦治疗期间爆发
智H1，ARENDS P1，Reijnders JG1，凯里I2，布朗A3，法萨诺M4，Mutimer D5，Deterding K6，吴YH5，彼得森J7，范博梅尔F8，德Knegt RJ1，Santantonio TA4，伯格T8，威尔兹尔TM9，魏德迈H6，布提M10，Pradat酒店P11，Zoulim F11，汉森B1，扬森HL1,12; VIRGIL监测研究组（欧洲监测网络对病毒的抗性警惕）。
胃肠病学和肝病，伊拉兹马斯MC大学医学中心的鹿特丹，荷兰鹿特丹的作者信息教研室。肝病消化科和，伦敦国王学院，伦敦，英国教研室。肝病消化科和伦敦帝国学院，伦敦，英国3Department。传染病4Clinic，福贾，福贾，意大利大学。 5Centre肝病研究，NIHR生物医学研究所的肝病，伯明翰及伊利沙伯医院，英国伯明翰大学。消化内科，肝病，内分泌科医学院汉诺威，汉诺威，德国系。 7Ifi研究所阿斯科勒比俄斯KLINIK圣乔治，汉堡，德国。肝病大学医院莱比锡，德国莱比锡8Department。 9Medizinische KLINIK 1，KLINIKUM DER歌德安大学，法兰克福，德国。肝病医院瓦尔代希伯伦，巴塞罗那，西班牙10Department。肝病的11Department，总医院去红十字山收容所Civils里昂，法国里昂。 12Toronto中心肝病大学健康网络，加拿大多伦多。
抽象
背景与目的：
本次发病及一线核苷（酸）类似物IDE治疗期间爆发的后果在很大程度上是未知。我们的目的是探讨慢性乙型肝炎（CHB）长期恩替卡韦（ETV）中的发生率和ALT爆发的结果。
方法：
与单用恩替卡韦从11个欧洲中心接受治疗的慢性乙肝患者进行了研究。爆发被定义为> 3倍的ALT升高基线或最低的治疗水平，绝对ALT正常> 3倍上限进行比较。爆发被指定为主机诱导（由HBV DNA下降之前），病毒诱导（HBV DNA增加），或不确定的（稳定的HBV DNA）。
结果：
729例患者恩替卡韦治疗3。5年中位数。 30例患者开发出的6.3％，累计发病率爆发在今年5基线的HBeAg阳性（HR 2.84，P = 0.005）和高HBV DNA（HR 1.30，P = 0.003）预测爆发。有12（40％）的主机引起的，7（23％）的病毒引起的，和11（37％）不确定弹。主机引起爆发出现早于病毒引起的（中位数：15主场迎战83周; P = 0.027）或不确定的爆发（15日主场109周; P = 0.011）。主机诱导爆发用生化缓解相关，和HBeAg（N = 3）与HBsAg（N = 2）血清转化被独占患者这些爆发之间观察到。病毒引起的爆发用恩替卡韦耐药（2例）以及不遵守相关的（N = 1）。
结论：
ALT爆发ETV期间发生在这个现实生活的人群低。 ETV的患者可以安全地继续与主机引起的爆发。治疗依从性和耐药性，必须在患者的病毒引起的爆发进行评估。本文由版权保护。版权所有。
本文由版权保护。版权所有。
关键词：
ALT;慢性乙型肝炎;恩替卡韦;眩光。核苷（酸）类似物IDE

9病成医

有高人给归纳解释一下吗？这斯蒂芬的中文跟英文一样看不明白。

小民百姓

ALT 异常（肝功异常）分为两种：
血清HBsAg和HBeAg转换时ALT异常；
耐药和服药依从性差导致的ALT异常。
现实中，服用恩替期间，ALT异常升高的几率低。有时宿主导致的ALT异常升高，意味着血清转换，这时服用恩替，是安全的。
另外就是，对因为耐药问题，和长期用药依从性差，而导致的ALT升高，应该注意评估。

小民百姓

楼主汉语水平不比英语差，懒得翻译而已！
搜集文献资料，有意义
资料可以参考，不能照搬，有的资料研究水平，并不在国内水平之上