患者复发慢性乙型肝炎后核苷（t）ide严格标准退出：前瞻性

StephenW

Hepatol Res. 2016 Nov 7. doi: 10.1111/hepr.12836. [Epub ahead of print]
Clinical characteristics and outcomes of patients with recurrent chronic hepatitis B after nucleos(t)ide analog withdrawal with stringent cessation criteria: A prospective cohort study.Liu Z1,2, Liu F1, Wang L1, Liu Y3, Zhang M2, Li T1.
Author information

• 1Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China.
• 2Jinan Infectious Disease Hospital, Shandong University School of Medicine, Jinan, China.
• 3Yantai Infectious Disease Hospital, Yantai, China.
  

AbstractAIM: The aim of this study was to explore the clinical characteristics and outcomes of patients with recurrent chronic hepatitis B meeting the cessation criteria outlined by the 2008 Asian Pacific Association for the Study of the Liver guidelines.
METHODS: In total, 223 chronic hepatitis B patients who met the cessation criteria and discontinued nucleos(t)ide analog therapy were prospectively included. They were monitored monthly during the first 4 months and every 3-6 months thereafter. Early relapse was defined as viral relapse (serum hepatitis B virus [HBV] DNA >104 copies/mL) confirmed within 3 months after cessation.
RESULTS: Of the 38 hepatitis B e antigen (HBeAg)-positive relapse cases, 44.7%, 65.8%, 76.3% and 89.5% occurred within 3 months, 6 months, 12 months, and 48 months, respectively; in the 49 HBeAg-negative relapse cases, 44.9%, 51.0%, 77.6% and 91.8% occurred within 3, 6, 12 and 36 months, respectively. Time to undetectable HBV DNA was a predictive factor of early relapse. Viral relapses were accompanied by elevated alanine aminotransferase in 70 (80.5%) patients. A peak alanine aminotransferase 10 times over the upper limit of normal after relapse was observed in 15.8% of the HBeAg-positive and 22.4% of the HBeAg-negative patients. Hepatic decompensation and liver failure were not observed.
CONCLUSIONS: For HBeAg-positive and HBeAg-negative patients meeting stringent cessation criteria, at least 4 years and 3 years of close follow-up are necessary. For those with a longer time to undetectable HBV DNA, more attention should be paid to the early stages after cessation. Nucleos(t)ide analog withdrawal in selected non-cirrhotic patients is generally safe, although close monitoring and timely intervention are needed.

© 2016 The Japan Society of Hepatology.

KEYWORDS: hepatitis B; nucleos(t)ide analogs; outcome; relapse/recurrence; safety

PMID:27917568DOI:10.1111/hepr.12836

StephenW

Hepatol Res。 2016 Nov 7. doi：10.1111 / hepr.12836。 [打印前的电子版]
患者复发慢性乙型肝炎后核苷（t）ide严格标准退出严格标准：前瞻性队列研究。
临床特点和患者复发慢性乙型肝炎后核苷（t）ide模拟退出与严格的戒烟标准：前瞻性队列研究。
Liu Z1,2，Liu F1，Wang L1，Liu Y3，Zhang M2，Li T1。
作者信息

    山东大学第二医院传染病与肝病学系，济南市。
    2山东大学医学院附属济南传染病医院，济南。
    中国烟台烟台传染病医院。

抽象
目标：

本研究的目的是探讨符合2008年亚太太平洋肝脏研究协会所规定的停止标准的复发性慢性乙型肝炎患者的临床特征和结果。
方法：

总共有223名符合戒烟标准和停用的核苷类似物治疗的慢性乙型肝炎患者被包括在内。他们在前4个月内每月监测一次，之后每3-6个月监测一次。早期复发被定义为在停止后3个月内证实的病毒复发（血清乙型肝炎病毒[HBV] DNA> 104拷贝/ mL）。
结果：

在38例乙型肝炎e抗原（HBeAg）阳性复发病例中，44.7％，65.8％，76.3％和89.5％分别发生在3个月，6个月，12个月和48个月内;在49例HBeAg阴性复发病例中，在3,6,12和36个月内分别发生44.9％，51.0％，77.6％和91.8％。到不可检测的HBV DNA的时间是早期复发的预测因素。在70例（80.5％）患者中病毒性复发伴有升高的丙氨酸氨基转移酶。在15.8％的HBeAg阳性和22.4％的HBeAg阴性患者中观察到复发后的正常上限的10倍的峰值丙氨酸转氨酶。没有观察到肝代偿失调和肝衰竭。
结论：

对于符合严格戒烟标准的HBeAg阳性和HBeAg阴性患者，需要至少4年和3年的密切随访。对于具有较长时间检测不到HBV DNA的患者，应更加注意停药后的早期阶段。在所选非肝硬化患者中的Nucleos（t）ide类似物戒断通常是安全的，尽管需要密切监测和及时干预。

©2016日本肝病学会。
关键词：

乙型肝炎;核苷（t）ide类似物;结果;复发/复发安全

PMID：
    27917568
DOI：
    10.1111 / hepr.12836