肝硬化对恩替卡韦对慢性乙型肝炎的治疗反应没有影响

StephenW

Cirrhosis has no impact on therapeutic responses of entecavir for chronic hepatitis B

Wang, Pin-Chao; Wei, Tao-Yang; Tseng, Tai-Chung; Lin, Hans Hsienhong; Wang, Chia-Chi
European Journal of Gastroenterology & Hepatology: August 2017 - Volume 29 - Issue 8 - p 946–950
doi: 10.1097/MEG.0000000000000897
Original Articles: Hepatitis

    Abstract
    Author Information

Department of Gastroenterology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, School of Medicine, Tzu Chi University, Hualien, Taiwan

Correspondence to Chia-Chi Wang, MSc, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Road, Xindian Area, New Taipei City 23142, Taiwan Tel: +886 2 6628 9779 x2335; fax: +886 2 6628 9009; e-mail: [email protected]

Received November 13, 2016

Accepted April 10, 2017


Objective: As the efficacy of a direct antiviral agent is reduced in cirrhotic chronic hepatitis C patients, prolonged duration of treatment or addition of ribavirin is recommended to improve the rates of sustained virological response. However, the impact of cirrhosis on the efficacy of antiviral treatment for chronic hepatitis B (CHB) remained unclear.

Patients and methods: This retrospective cohort study screened entecavir (ETV)-treated CHB patients in Taipei Tzu Chi Hospital from January 2007 till October 2014. The diagnosis of cirrhosis was made on the basis of clinical/imaging or histologic findings. The primary endpoints were hepatitis B e antigen (HBeAg) loss in HBeAg-positive patients and undetectable hepatitis B virus (HBV) DNA in the overall study population. Initial virological response is defined as undetectable HBV DNA at 1-year ETV treatment.

Results: A total of 381 (262 men; mean age: 49.6±12.9 years) CHB patients were recruited for the final analysis. Of these, 138 were cirrhotic. In 143 HBeAg-positive patients, there was no difference in the rates of 1- and 2-year HBeAg loss between cirrhotic and noncirrhotic patients (P=0.226 and 0.729, respectively). In the overall population, the rate of 1-year undetectable HBV DNA was higher in patients with cirrhosis than those without cirrhosis (76.1 vs. 64.2%, P=0.016). The rate of 2-year undetectable HBV DNA was not different between these two groups. Using multivariate logistic regression analysis, baseline HBV DNA levels (P=0.006) and HBeAg status (P=0.007), were associated with initial virological response, but not cirrhosis.

Conclusion: Therapeutic responses of ETV are not decreased in cirrhotic CHB patients. Thus, cirrhotic CHB patients can be treated with ETV without the need for dose adjustment.

StephenW

肝硬化对恩替卡韦对慢性乙型肝炎的治疗反应没有影响

王宝超魏涛，陶阳;曾;林汉森;王志智
欧洲胃肠病学与肝病杂志：2017年8月 - 第29卷 - 第8期 - 第946-950页
doi：10.1097 / MEG.0000000000000897
原文：肝炎

    抽象
    作者资料

台北慈济医院消化内科，慈济医学基金会，慈济大学医学院，台湾花莲

新华社新店区289路佛教慈济医学基金会台北慈济医院消化内科，内科，内科系内科医学科，23142电话：+886 2 6628 9779 x2335;传真：+886 2 6628 9009;电子信箱：[email protected]

于2016年11月13日收到

2017年4月10日接受


目的：随着肝硬化慢性丙型肝炎患者直接抗病毒药物的疗效降低，建议延长治疗持续时间或加入利巴韦林，以提高持续的病毒学应答率。然而，肝硬化对抗病毒治疗对慢性乙型肝炎（CHB）疗效的影响尚不清楚。

患者及方法：回顾性队列研究从2007年1月至2014年10月，对台北慈济医院的恩替卡韦（ETV）治疗CHB患者进行筛查。根据临床/影像学检查或组织学检查结果确定肝硬化。主要终点是HBeAg阳性患者乙型肝炎e抗原（HBeAg）损失和总体研究人群中不可检测的乙型肝炎病毒（HBV）DNA。初步病毒学应答定义为1年ETV治疗时检测不到的HBV DNA。

结果：招募了381名（262名男性;平均年龄：49.6±12.9岁）CHB患者进行最终分析。其中138例肝硬化。在143例HBeAg阳性患者中，肝硬化和非肝硬化患者1年和2年HBeAg损失率分别没有差异（P = 0.226和0.729）。在总体人群中，肝硬化患者1年无法检出的HBV DNA水平高于无肝硬化患者（76.1例，64.2％，P = 0.016）。两组之间2年无法检测HBV DNA的比例没有差异。使用多变量逻辑回归分析，基线HBV DNA水平（P = 0.006）和HBeAg状态（P = 0.007）与初始病毒学应答而不是肝硬化有关。

结论：肝硬化CHB患者ETV治疗效果并未降低。因此，肝硬化CHB患者可以用ETV治疗，无需进行剂量调整。