在协恩替卡韦治疗结束乙肝表面抗原和复发风险的血清水平

StephenW

Clin Gastroenterol Hepatol. 2016 Mar 24. pii: S1542-3565(16)00330-X. doi: 10.1016/j.cgh.2016.03.024. [Epub ahead of print]
Association Between Serum Level of Hepatitis B Surface Antigen at End of Entecavir Therapy and Risk of Relapse in e Antigen-negative Patients.Hsu YC1, Mo LR2, Chang CY3, Wu MS4, Kao JH5, Wang WL3, Yang TH6, Wang CS6, Chiang MF6, Chen CC4, Fang YJ7, Hung HW8, Wu CY9, Lin JT10.
Author information

• 1Center for Database Research, E-Da Hospital, Kaohsiung City; Division of Gastroenterology, E-Da Hospital, Kaohsiung City; School of Medicine for International Students, I-Shou University, Kaohsiung City; Graduate Institute of Clinical Medicine, China Medical University, Taichung City. Electronic address: [email protected].
• 2Superintendent Office, Tainan Municipal Hospital, Tainan City.
• 3Division of Gastroenterology, E-Da Hospital, Kaohsiung City.
• 4Department of Internal Medicine, National Taiwan University Hospital, Taipei City.
• 5Graduate Institute of Clinical Medicine, National Taiwan University, Taipei City.
• 6Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan County.
• 7Department of Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin County.
• 8Taipei Institute of Pathology, Taipei City.
• 9Graduate Institute of Clinical Medicine, China Medical University, Taichung City; Division of Gastroenterology, Taichung Veterans General Hospital, Taichung City; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City. Electronic address: [email protected].
• 10School of Medicine, Fu Jen Catholic University, New Taipei City; all institutions in Taiwan.
  

AbstractBACKGROUND & AIMS: We investigated whether serum levels of hepatitis B surface antigen (HBsAg) level at the end of entecavir treatment was associated with risk of relapse.
METHODS: We performed a prospective multi-center study of 161 consecutive patients with chronic hepatitis B in whom the hepatitis B virus (HBV) was no longer detected after 3 years or more of entecavir therapy. Treatment ended between July 1, 2011 and July 1, 2015. Patients were monitored for clinical relapse (HBV DNA>2000 IU/mL and level of alanine aminotransferase more than 2-fold the upper limit of normal) and virologic relapse (HBV DNA>2000 IU/mL). Outcomes were calculated using the Kaplan Meier method and risk factors were identified by the Cox proportional hazard modeling.
RESULTS: Two years after therapy ended, 49.2% of patients in the entire cohort had a clinical relapse (95% confidence interval [CI], 40.9%-58.1%) and 81.7% had a virologic relapse (95% CI, 74.3%-88.0%). Among patients who were hepatitis B e antigen (HBeAg) negative at the end of therapy, 39.2% had a clinical relapse (95% CI, 30.3-49.6%) and 77.4% had a virologic relapse (95% CI, 68.6-85.2%). Serum level of HBsAg was associated with relapse in the HBeAg-negative patients (Ptrend=.006 for clinical relapse, Ptrend=.0001 for virologic relapse). In multivariate Cox regression analysis, the hazard ratio (per log IU/mL increment) for clinical relapse was 2.47 (95% CI, 1.45-4.23) and for virologic relapse was 1.80 (95% CI, 1.33-2.45). The 11 (9%) patients with levels of HBsAg <10 IU/mL did not relapse.
CONCLUSIONS: Serum level of HBsAg is associated with risk of relapse in patients who are HBeAg negative after treatment with entecavir. A low titer of HBsAg might be used to identify patients at low risk for relapse after treatment.
Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.


KEYWORDS: ALT; liver disease; prognostic factor; response to therapy

StephenW

临床Gastroenterol肝脏病。 2016年24月PII：S1542-3565（16）00330-X。 DOI：10.1016 / j.cgh.2016.03.024。 [打印EPUB提前]
在协恩替卡韦治疗结束乙肝表面抗原和复发风险的血清水平之间的e抗原阴性的患者。
许YC1，莫LR2，张CY3，吴MS4，花王JH5，王WL3，杨TH6，王CS6，蒋MF6，陈CC4，方YJ7，洪HW8，吴CY9，林JT10。
作者信息

    1Center对于数据库的研究，E-大医院，高雄市;消化内科，E-大医院，高雄市司;医学院留学生，义守大学，高雄;中国医科大学临床医学研究所，台中市。电子地址：[email protected]。
    2Superintendent办公室，台南市立医院，台南市。
    消化3Division，E-大医院，高雄市。
    内科，台大医院，台北市4Department。
    国立台湾大学临床医学研究所5Graduate，台北市。
    内科，罗东婆，爱医院，宜兰县的6Department。
    医学7Department，台大医院云林科，云林县。
    病理8Taipei研究所，台北市。
    中国医科大学临床医学9Graduate研究所，台中市;消化内科，台中荣民总医院，台中市司;国立阳明大学医学系，医学院，台北市。电子地址：[email protected]。
    医药，辅仁大学，新北市的10School;所有机构在台湾。

抽象
背景与目的：

我们研究了在恩替卡韦治疗结束乙型肝炎表面抗原的血清水平（HBsAg）的水平是否与复发的风险。
方法：

我们进行了连续161例慢性乙型肝炎人乙型肝炎病毒（HBV）在经过3年以上的恩替卡韦治疗不再检测一项前瞻性多中心研究。 2011年7月1日和7月1日之间结束治疗，2015年患者进行了临床复发监测（HBV DNA> 2000 IU / mL和谷丙转氨酶水平超过2倍正常值上限）和病毒学复发（HBV DNA> 2000国际单位/毫升）。结果采用Kaplan Meier法计算及风险因素进行Cox比例风险模型确定。
结果：

治疗结束两年后，患者在整个队列49.2％有一位临床复发（95％可信区间[CI]，40.9％-58.1％）和81.7％有一位病毒学复发（95％CI，74.3％-88.0％ ）。在谁是病人乙肝e抗原在治疗结束（HBeAg）阳性阴性，39.2％有一位临床复发（95％CI，30.3-49.6％）和77.4％有一位病毒学复发（95％CI，68.6-85.2％ ）。乙肝表面抗原血清水平与在HBeAg阴性患者（Ptrend = 0.006临床复发，对于复发病毒学= Ptrend 0.0001）复发有关。在多元回归分析，危险比（每登录IU / mL的增量），为临床复发率2.47（95％CI，1.45-4.23）和病毒学复发率1.80（95％CI，1.33-2.45）。 11（9％）的患者用HBsAg的水平<10IU / mL的未复发。
结论：

乙肝表面抗原血清水平与患者谁是恩替卡韦治疗后HBeAg阴性的复发风险。乙肝表面抗原的低滴度可能被用来在治疗后复发的低风险，以确定病人。

版权所有©2016年AGA研究所。发布时间由Elsevier公司保留所有权利。
关键词：

ALT;肝脏疾病;预后因素;对治疗的反应

小民百姓

停药时，HBsAg定量越低，将来的复发率越低！
看来，长期抗病毒的停药标准，只能定为“表面抗原HBsAg消失”。
要是表面抗原没有消失，就一直坚持吃下去！