治疗乙型肝炎病毒（HBV）DNA水平和中止慢性乙型肝炎患者核

StephenW

Off-Treatment Hepatitis B Virus (HBV) DNA Levels and the Prediction of Relapse After Discontinuation of Nucleos(t)ide Analogue Therapy in Patients With Chronic Hepatitis B: A Prospective Stop Study
Jiawei Cao
Heng Chi
Tao Yu
Zhandong Li
Bettina E. Hansen
Xiaoyong Zhang
Chunxiu Zhong
Jian Sun
Jinlin Hou
Harry L. A. Janssen

J Infect Dis (2017) 215 (4): 581-589.
DOI:
https://doi.org/10.1093/infdis/jix025
Published:
19 January 2017
Article history

Abstract
Background.

The optimal management remains unknown after nucleos(t)ide analogue (NA) discontinuation in patients with chronic hepatitis B (CHB). This prospective study investigated the role of off-treatment viral kinetics in predicting relapse after discontinuation of NA therapy.
Methods.

A total of 82 noncirrhotic Asian patients with CHB who discontinued NA therapy according to international guidelines were prospectively followed. Patients with a hepatitis B virus (HBV) DNA level of >2000 IU/mL and an alanine aminotransferase (ALT) level of >2 times the upper limit of normal (clinical relapse) were retreated.
Results.

Sixty patients were HBV envelope antigen (HBeAg) positive at the start of treatment, and 22 were HBeAg negative. Clinical relapse developed in 28 patients (2-year rates, 31% among HBeAg-positive patients and 53% among HBeAg-negative patients). Age of ≤35 years (hazard ratio [HR], 0.37; P = .026) and end-of-treatment HBsAg level of ≤200 IU/mL (HR, 0.39; P = .078) were independently associated with lower relapse rates. A high risk of biochemical relapse (defined as an ALT level of >2 times the upper limit of normal) was observed if the HBV DNA level was >200000 IU/mL when the level was initially elevated, compared with HBV DNA levels of >2000 to ≤200000 IU/mL (HR, 8.42; P < .001). The risk of biochemical relapse was also high in patients with persistent elevation in the HBV DNA level (confirmed to be >2000 IU/mL within 3 months), compared with the group with transient elevation (HR, 6.87; P < .001).
Conclusions.

After NA discontinuation, a lower relapse rate was observed in younger patients and in those with low end-of-treatment HBsAg levels. The level and persistence of off-treatment elevated HBV DNA levels were useful in the prediction of a subsequent biochemical relapse and may thus be used to guide off-treatment management.
Treatment cessation, antiviral agents, hepatitis B, off-treatment management

StephenW

治疗乙型肝炎病毒（HBV）DNA水平和中止慢性乙型肝炎患者核素（t）ide模拟治疗后复发的预测：前瞻性停止研究
曹家伟
恒驰
陶宇
李东东
Bettina E. Hansen
张晓勇
春秀忠
建孙
金林侯
哈里·A.詹森

J Infect Dis（2017）215（4）：581-589。
DOI：
https://doi.org/10.1093/infdis/jix025
发布时间：
2017年1月19日
文章历史

抽象
背景。

在慢性乙型肝炎（CHB）患者的核心（t）ide类似物（NA）停药后，最佳管理仍然未知。这项前瞻性研究调查了脱离治疗病毒动力学在停止NA治疗后预测复发的作用。
方法。

根据国际指南，共有82例非肝硬化患者CHB终止NA治疗。乙型肝炎病毒（HBV）DNA水平> 2000 IU / mL，丙氨酸氨基转移酶（ALT）水平>正常水平（临床复发）> 2倍的患者被撤回。
结果。

60例HBeAg阳性患者，HBeAg阴性22例。 28例患者临床复发（2年率，HBeAg阳性患者中31％，HBeAg阴性患者53％）。年龄≤35岁（危险比[HR]，0.37; P = 0.026），治疗结束时HBsAg水平≤200IU / mL（HR，0.39; P = 0.078）独立相关，复发率较低。如果HBV DNA水平最初升高时HBV DNA水平> 200000 IU / mL，与HBV DNA水平> 2000相比，观察到生化复发风险高（定义为ALT水平>正常上限> 2倍）至≤200000IU/ mL（HR，8.42; P <0.001）。与短暂性抬高组相比，HBV DNA水平持续升高（证实在3个月内为> 2000 IU / mL）患者生化复发的风险也较高（HR为6.87; P <0.001）。
结论。

在NA中止后，在年轻患者和治疗结束治疗HBsAg水平的患者中观察到较低的复发率。脱落的水平和持续性提高HBV DNA水平可用于预测随后的生化复发，因此可用于指导治疗管理。
治疗戒烟，抗病毒药，乙型肝炎治疗管理

neilhbver

如果因为经济因素停药，得不偿失