临床结果和预测复发的慢性乙肝患者口服抗病毒药物治疗停

StephenW

Journal of Gastroenterology

August 2016, Volume 51, Issue 8, pp 830-839

First online: 19 December 2015
Clinical outcomes and predictors for relapse after cessation of oral antiviral treatment in chronic hepatitis B patients

    Kyu Sik Jung , Jun Yong Park , Young Eun Chon, Hyon-Suk Kim, Wonseok Kang, Beom Kyung Kim, Seung Up Kim, Do Young Kim, Kwang-Hyub Han and 1 more


Abstract
Background

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

Kyu Sik Jung and Jun Yong Park have equally contributed to this work.
Electronic supplementary material

StephenW

胃肠病学杂志

2016年8月，51卷，第8期，第830-839

首先在线：2015年12月19日
临床结果和预测复发的慢性乙肝患者口服抗病毒药物治疗停止后

    圭植荣，勇俊园，杨恩川，玄淑金，Wonseok康，范庆金，升最多金，难道扬金，刘广Hyub汉族和​​1个


抽象
背景

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

总共有连续113例慢性乙型肝炎（45 HBeAg阳性和68例HBeAg阴性慢性乙型肝炎患者），谁见了NA治疗停止标准为每亚太协会肝（APASL）指南的研究，共入选在这个前瞻性队列研究。主要终点是评价1年内复发病毒学（VR）率，这是NA停止治疗后定义为乙肝病毒的再现（HBV）-DNA> 2,000 IU / mL的。在这个队列中，恩替卡韦在81（71.7％）和拉米夫定，使用了32（​​28.3％）的患者。
结果

在NA治疗后1年，VR发生在26（57.8％），HBeAg阳性患者，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> 2000,000国际单位/毫升（OR 9.285; 95％CI 1.545-55.795; P = 0.036）被确定为HBeAg阳性患者的独立危险因素VR和年龄> 40岁（OR 6.690; 95％CI 1.314-34.057; P = 0.022）（95％CI 1.187-11.856; P = 0.024 3.751 OR）被确定和结束治疗>日志3.7 IU / mL的HBcrAg水平在HBeAg阴性患者。在随访期间，没有肝功能失代偿，也不（HCC）发生肝癌和HBV DNA抑制在谁接受了抗病毒再治疗的患者实现。
结论

我们的数据表明，如果候选人是使用独立危险因素适当地选择可应用的APASL停止规则。然而，应当NA治疗和长期预后的停止后进行定期监测需要进一步评估。
关键词
慢性乙型肝炎抗病毒治疗核苷（酸）类似物IDE耐久性复发

圭植荣和君永园区已同等贡献这项工作。