患病率及危险因素与核苷（酸）类似物治疗慢性乙型肝炎患

StephenW

J Viral Hepat. 2016 Aug 9. doi: 10.1111/jvh.12579. [Epub ahead of print]
Prevalence and risk factors for viral blipping in chronic hepatitis B patients treated with nucleos (t) ide analogues.Brahmania M1, Brouwer WP2, Hansen T1, Mazzulli T3, Feld J1, Wong D1, Kowgier M1,4, Janssen HL1.
Author information

• 1Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
• 2Department of Gastroenterology & Hepatology, Erasmus Medical Center University Hospital, Rotterdam, The Netherlands.
• 3Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
• 4Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
  

AbstractThe clinical relevance of viral blipping during nucleos (t) ide analogue (NA) treatment is unclear in chronic hepatitis B (CHB). We investigated the prevalence, risk factors and clinical outcomes for those with viral blipping during NA treatment. A retrospective cohort study investigated consecutively treated CHB patients from May 2008 to February 2015 on the NAs such as entecavir (ETV), tenofovir (TDF) and lamivudine (LAM). Included patients were previously treatment naive. Viral blipping was defined as serum HBV DNA >20 IU/mL on one occasion, and not >200 IU/mL, with subsequent measurement returning to undetectable levels, that is <20 IU/mL. A total of 242 treatment-compliant CHB patients were included with 44 (18.2%) experiencing viral blipping. In multivariable Cox regression, Asian race (HR=7.40, 95% CI 1.01-54.29, P<.049), LAM therapy (vs ETV/TDF, HR=2.53, 95% CI 1.29-4.95, P<.007), higher creatinine (per SD, HR=1.47, 95% CI 1.21-1.79, P<.001), HBeAg positivity (HR=2.68, 95% CI 1.39-5.03, P<.003) and longer time to achieve undetectable HBV DNA (per month, HR=1.05, 95% CI 1.02-1.08, P=.001) were associated with an increased risk of viral blipping. Viral blipping did not show any significant association with viral breakthrough, HBsAg loss, ALT flares or disease progression. Viral blipping is a frequent event during NA therapy; however, it did not lead to any clinically significant outcomes. Thus, it may not require more frequent blood work and patient visits in clinical practice.
© 2016 John Wiley & Sons Ltd.


KEYWORDS: HBV treatment; chronic hepatitis B; nucleos (t) ide analogue treatment; viral blipping

PMID:27502526DOI:10.1111/jvh.12579

StephenW

Ĵ病毒Hepat。 2016年9月DOI：10.1111 / jvh.12579。 [打印EPUB提前]
患病率及危险因素与核苷（酸）类似物治疗慢性乙型肝炎患者病毒blipping。
Brahmania M1，布劳威尔WP2，汉森T1，T3 Mazzulli，费尔德J1，黄D1，Kowgier M1,4，扬森HL1。
作者信息

    消化内科的1区，多伦多综合医院，多伦多，多伦多大学，加拿大。
    肠胃病学和肝脏，Erasmus医学中心大学医院，荷兰鹿特丹的教研室。
    检验医学与病理学，Mount Sinai医院，多伦多大学，多伦多，加拿大3Department。
    生物统计学4Department，公共卫生，多伦多大学，多伦多，加拿大达拉拉娜学校。

抽象

病毒blipping期间核苷（酸）类似物IDE（NA）治疗的临床意义是慢性乙型肝炎（CHB）不清楚。我们NA治疗期间调查的患病率，危险因素和临床结果为那些与病毒blipping。回顾性队列研究调查了连续治疗的慢性乙肝患者，从2008年5月至NAS 2015年2月，如恩替卡韦（ETV），替诺福韦（TDF）和拉米夫定（LAM）。包括患者以前治疗天真。病毒blipping定义为血清HBV DNA> 20 IU / mL的一次，而不是> 200 IU / ml，用后续计量回归检测不到的水平，即<20国际单位/毫升。共有242治疗标准的慢性乙型肝炎患者被纳入44例（18.2％）经历了病毒blipping。在多变量Cox回归，亚洲人种（HR = 7.40，95％CI 1.01-54.29，P <.049），LAM治疗（VS ETV / TDF，HR = 2.53，95％CI 1.29-4.95，P <0.007），肌酐高（每SD，HR = 1.47，95％CI 1.21-1.79，P <0.001），e抗原阳性（HR = 2.68，95％CI 1.39-5.03，P <0.003）和更长的时间来实现检测不到HBV DNA （每月，HR = 1.05，95％CI 1.02-1.08，P = 0.001）与病毒blipping的风险增加有关。病毒blipping没有表现出与病毒突破，HBsAg消失，ALT耀斑或疾病进展的任何显著的关联。病毒blipping是NA治疗过程中经常活动;然而，它并没有导致任何临床显著结果。因此，可以不要求更频繁的血液工作并在临床实践中患者就诊。

2016年©约翰·威利父子有限公司
关键词：

乙肝治疗;慢性乙型肝炎;核苷（酸）类似物IDE治疗;病毒blipping

结论：
    27502526
DOI：
    10.1111 / jvh.12579