乙型肝炎表面抗原损失和HBeAg阴性肝硬化患者停止或继续核苷

StephenW

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        J Viral Hepat. 2017 Jan 27. doi: 10.1111/jvh.12683. [Epub ahead of print]
Hepatitis B surface antigen loss and clinical outcomes between HBeAg-negative cirrhosis patients who discontinued or continued nucleoside analog therapy.Hung CH1, Wang JH1, Lu SN1, Hu TH1, Lee CM1, Chen CH1.
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• 1Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan.
  

AbstractWe investigated the incidence and predictors of post-treatment hepatitis B virus (HBV) relapse and hepatitis B surface antigen (HBsAg) loss. The rates of HBsAg loss and hepatocellular carcinoma (HCC) development in HBeAg-negative patients with cirrhosis who continued nucleoside analog (NA) treatment were compared with those who discontinued treatment. Compensated cirrhotic patients who had discontinued NA treatment for at least 12 months (discontinuing group; n=73) and patients who continued entecavir treatment for at least 4 years (continuing group; n=158) were recruited. Serum HBsAg levels were analyzed at the end of treatment (discontinuing group) or at 2.5-3 years of treatment (continuing group). In the discontinuing group, the 6-year cumulative incidence of post-treatment virological relapse and HBsAg loss were 56.3% and 46.7%, respectively. The end-of-treatment HBsAg level of 300 IU/mL was a cut-off value for subsequent post-treatment HBsAg loss and sustained response. In the continuing group, HBsAg loss occurred in 5 of 158 patients. Cox regression analysis showed that HBsAg levels in the discontinuing group were independent predictors for HBsAg loss in all patients and 104 propensity score (PS) matched patients. There was no significant difference in HCC development between the groups in all patients and 104 PS-matched patients. Two patients experienced post-treatment alanine aminotransferase flare with hepatic decompensation, and neither of them died after retreatment. In conclusion, HBeAg-negative patients with cirrhosis who discontinued NA treatment might have a higher rate of HBsAg loss and their risk of developing HCC did not increase compared to those who continued entecavir treatment. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

KEYWORDS: cirrhosis; entecavir; hepatitis B surface antigen; hepatitis B virus; hepatocellular carcinoma

PMID:28130815DOI:10.1111/jvh.12683

StephenW

J病毒Hepat。 doi：10.1111 / jvh.12683。 [打印前的电子版]
乙型肝炎表面抗原损失和HBeAg阴性肝硬化患者停止或继续核苷类似物治疗的临床结果。
Hung CH1，Wang JH1，Lu SN1，Hu TH1，Lee CM1，Chen CH1。
作者信息

    肝内科，高雄长庚纪念医院和长庚大学医学院台湾内科学系。

抽象

我们调查了治疗后乙型肝炎病毒（HBV）复发和乙型肝炎表面抗原（HBsAg）损失的发病率和预测因子。将继续进行核苷类似物（NA）治疗的HBeAg阴性肝硬化患者的HBsAg消失和肝细胞癌（HCC）发生率与停止治疗的患者进行比较。招募了已停止NA治疗至少12个月（停用组; n = 73）和继续恩替卡韦治疗至少4年（持续组; n = 158）的患者的补偿性肝硬化患者。在治疗结束时（停用组）或2.5-3年的治疗（连续组）分析血清HBsAg水平。在停药组中，治疗后病毒学复发和HBsAg消失的6年累积发病率分别为56.3％和46.7％。治疗结束时的300IU / mL的HBsAg水平是随后的治疗后HBsAg丧失和持续反应的临界值。在继续组中，HBsAg损失发生在158名患者中的5名。 Cox回归分析显示，停用组中的HBsAg水平是所有患者和104名倾向评分（PS）匹配患者中HBsAg消耗的独立预测因子。所有患者和104名PS匹配患者的组之间的HCC发展没有显着差异。两名患者经历了治疗后丙氨酸氨基转移酶flare与肝失代偿，并且他们都没有在再治疗后死亡。总之，停止NA治疗的HBeAg阴性肝硬化患者可能具有较高的HBsAg消耗率，并且与继续恩替卡韦治疗的患者相比，其发展HCC的风险没有增加。本文受版权保护。版权所有。

本文受版权保护。版权所有。
关键词：

肝硬化恩替卡韦乙型肝炎表面抗原;乙型肝炎病毒;肝细胞癌

PMID：
    28130815
DOI：
    10.1111 / jvh.12683

心如浮云

没看懂什么意思，楼主能否简要解释一下呢？

StephenW

回复 心如浮云 的帖子

HBeAg阴性肝硬化（补偿）患者，停止NA治疗的相比继续恩替卡韦治疗的,可能具有较高的HBsAg清除率, 其发展HCC的风险没有增加.

心如浮云

回复 StephenW 的帖子

是不是说，HBeAg阴性肝硬化（补偿）患者后期DNA肝功正常也可以考虑停药，也同样具有HBsAg清除率, 其发展HCC的风险没有增加。但是现在几乎所有的医生都认为肝硬化患者不论DNA是否阴性都需终身抗病毒。

StephenW

回复 心如浮云 的帖子

是.

HBeAg阴性肝硬化（补偿）患者停药 - 这是非常有争议的. 在台湾，医生相信这是可能, 但在欧美反对. 需要更多的研究.