在强效抗病毒治疗的早期阶段，治疗期肝炎病人的HBsAg明显下

StephenW

J Viral Hepat. 2017 Nov 28. doi: 10.1111/jvh.12833. [Epub ahead of print]
Great and rapid HBsAg decline in patients with on-treatment hepatitis flare in early phase of potent antiviral therapy.Jeng WJ1, Chen YC1, Liaw YF1.
Author information
1Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine Taipei, Taiwan.

AbstractHepatitis B surface antigen (HBsAg) decline during nucleos(t)ide analogue therapy in chronic hepatitis B with lower pretherapy alanine aminotransferase (ALT) is usually small and slow. This study aimed to investigate why ~10% of such patients showed "rapid HBsAg decline" ≥0.5 log10 IU/mL by month 6 of therapy. Patients with persistent pretherapy ALT <5X upper limit of normal (ULN) who had quantitative HBsAg (qHBsAg) at baseline, month 6 and 12 of entecavir or tenofovir therapy were studied. "On-treatment ALT elevation" was defined as >10% increase above baseline to >2X ULN during first 6 months of therapy. Of the 256 patients treated, 51 experienced transient "on-treatment ALT elevation" [Group A], including 30 (11.7%) with ALT elevation to 2-5X ULN [group A-1] and 21 (8.2%) flared to >5X ULN [group A-2]. The magnitude of qHBsAg decline and rate of "rapid HBsAg decline" by month 6 was significantly greater and more frequent in group A (-0.446 vs -0.042 log10 IU/mL; 45.1 vs 8.8%, respectively, P=0.000) than in the remaining 205 patients without on-treatment ALT elevation (group B), being greatest in patients with hepatitis flare (group A-2: -0.559 log10 IU/mL and 57.1%, respectively). In patients with therapy ≥2 years, patients with "on-treatment ALT elevation" also showed significantly greater annual HBsAg decline, more frequent to <100 IU/mL and 4 times higher HBsAg seroclearance rate. "On-treatment ALT elevation", especially flare >5X ULN, during entecavir or tenofovir therapy may enhance/accelerate HBsAg decline, suggesting the effect of immune restoration upon potent viral suppression. This article is protected by copyright. All rights reserved.


KEYWORDS: ALT elevation; chronic hepatitis B; cirrhosis; nucleos(t)ide analogue

PMID:29193573DOI:10.1111/jvh.12833

StephenW

J病毒肝脏。 2017年11月28日doi：10.1111 / jvh.12833。 [电子版提前打印]
在强效抗病毒治疗的早期阶段，治疗期肝炎病人的HBsAg明显下降。
曾伟杰1，陈玉麟1，廖玉芳1
作者信息

1
    台湾台北长庚大学医学院长庚医院肝脏研究室。

抽象

慢性乙型肝炎核苷（酸）类似物治疗期间乙型肝炎表面抗原（HBsAg）下降，治疗前丙氨酸转氨酶（ALT）通常较小且缓慢。本研究旨在探讨为什么约10％的这类患者在治疗6个月后出现“快速HBsAg下降”≥0.5log10 IU / mL。对恩替卡韦或替诺福韦治疗的基线，6个月和12个月时具有定量HBsAg（qHBsAg）的持续治疗前ALT <5X正常上限（ULN）患者进行了研究。治疗前ALT升高定义为在治疗前6个月内超过基线> 10％的增加。在治疗的256例患者中，51例出现ALT短期升高[A组]，其中30例（11.7％）ALT升高至2-5X ULN [A-1]，21例（8.2％）出现> 5X ULN [组A-2]。 A组患者qHBsAg下降幅度和“快速HBsAg下降”的比例显着高于A组（分别为-0.446 vs -0.042 log10 IU / mL; 45.1 vs 8.8％，P = 0.000）其余205例没有治疗中ALT升高的患者（B组），在肝炎发作的患者中最大（A-2组：-0.559 log10 IU / mL和57.1％）。在治疗≥2年的患者中，“治疗前ALT升高”患者的年HBsAg下降更明显，<100 IU / mL更频繁，HBsAg血清清除率更高。恩替卡韦或替诺福韦治疗期间“治疗前ALT升高”，特别是> 5X ULN，可能增强/加速HBsAg下降，表明免疫恢复对强效病毒抑制的作用。本文受版权保护。版权所有。
关键词：

ALT标高;慢性乙型肝炎;肝硬化;核苷（酸）类似物

结论：
    29193573
DOI：
    10.1111 / jvh.12833