乙型肝炎表面抗原随时间变化的血清梯度预测NA治疗后复发的

StephenW

BMC Gastroenterol. 2017 Dec 8;17(1):154. doi: 10.1186/s12876-017-0697-3.
Time-varying serum gradient of hepatitis B surface antigen predicts risk of relapses after off-NA therapy.Chien NH1,2,3, Huang YT4, Wu CY5,6, Chang CY2,7,8, Wu MS9, Kao JH9,10, Mo LR11, Tai CM8, Lin CW8, Yang TH12, Lin JT2,7,8, Hsu YC13,14,15,16.
Author information
1Cathay General Hospital, Taipei, Taiwan.2School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.3Sijhih Cathay General Hospital, New Taipei, Taiwan.4Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.5Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan.6Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.7Division of Gastroenterology, Fu-Jen Catholic University Hospital, New Taipei, Taiwan.8Division of Gastroenterology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.9Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.10Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.11Department of Internal Medicine, Tainan Municipal Hospital, Tainan, Taiwan.12Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan Country, Taiwan.13School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan. [email protected].14Division of Gastroenterology, Fu-Jen Catholic University Hospital, New Taipei, Taiwan. [email protected].15Division of Gastroenterology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan. [email protected].16, No.510, Zhongzheng Rd., Xinzhuang Dist, New Taipei City, 24205, Taiwan. [email protected].

AbstractBACKGROUND: The serum gradient of hepatitis B surface antigen (HBsAg) varies over time after cessation of nucleos(t)ide analog (NA) treatment in patients with chronic hepatitis B (CHB). The association between the time-varying HBsAg serum gradient and risk of relapse has not been elucidated.
METHODS: This multicenter cohort study prospectively enrolled CHB patients who discontinued 3 year-NA treatment. Eligible patients were serologically negative for HBeAg and viral DNA at NA cessation. The participants (n = 140) were followed every 3 months through HBsAg quantification. Virological and clinical relapses were defined as viral DNA levels >2000 IU/mL and alanine aminotransferase (ALT) levels >80 U/mL, respectively. The association of time-varying HBsAg levels with relapses was assessed through a time-dependent Cox analysis.
RESULTS: During a median follow-up of 19.9 (interquartile range [IQR], 10.6-25.3) months, virological and clinical relapses occurred in 94 and 49 patients, with a 2-year cumulative incidence of 79.2% (95% confidence interval [CI], 70.9%-86.4%) and 42.9% (95% CI, 34.1%-52.8%), respectively. The serum level of HBsAg was associated with virological (P < 0.001) and clinical (P = 0.01) relapses in a dose-response manner, with adjusted hazard ratios of 2.10 (95% CI, 1.45-3.04) and 2.32 (95% CI, 1.28-4.21). Among the patients (n = 19) whose HBsAg levels ever dropped below 10 IU/mL, only one and three patients subsequently developed clinical and virological relapses.
CONCLUSION: The serum gradient of HBsAg measured throughout the off-therapy observation is associated with the subsequent occurrence of virological and clinical relapses in CHB patients who discontinue NA treatment.


KEYWORDS: Chronic hepatitis B; Hepatitis B surface antigen quantification; Nucleos(t)ide analogs; Time-dependent Cox proportion hazards model

PMID:29221441DOI:10.1186/s12876-017-0697-3

StephenW

BMC Gastroenterol。 2017年12月8日; 17（1）：154。 doi：10.1186 / s12876-017-0697-3。
乙型肝炎表面抗原随时间变化的血清梯度预测NA治疗后复发的风险。
Chien NH1,2,3，Huang YT4，Wu CY5,6，Chang CY2,7,8，Wu MS9，Kao JH9,10，Mo LR11，Tai CM8，Lin CW8，Yang TH12，Lin JT2,7,8，Hsu YC13,14,15,16。
作者信息

1
    台湾台北国泰总医院。
2
    台湾新北辅仁大学医学院。
3
    台北新北市四国总医院
4
    中国科学院统计科学研究所台湾台北。
五
    台中台中军区总医院消化科。
6
    国立阳明大学医学院医学系台湾台北
7
    台北新天辅大学附属医院消化科。
8
    台湾高雄市义大医院消化科。
9
    台湾台北大学医学院内科。
10
    台湾台北大学临床医学研究所
11
    台湾台南市立医院内科。
12
    台湾宜兰县洛朗-爱医院内科。
13
    台湾新北辅仁大学医学院。 [email protected]。
14
    台北新天辅大学附属医院消化科。 [email protected]。
15
    台湾高雄市义大医院消化科。 [email protected]。
16
    ，新中市新庄区中正路510号，邮编24205。 [email protected]。

抽象
背景：

乙型肝炎表面抗原（HBsAg）的血清梯度在慢性乙型肝炎（CHB）患者停止核苷（酸）类似物（NA）治疗后随时间变化。时变HBsAg血清梯度与复发风险之间的关联尚未阐明。
方法：

这项多中心队列研究前瞻性纳入了停止3年NA治疗的CHB患者。符合条件的患者在NA停止时HBeAg和病毒DNA血清学阴性。 HBsAg定量每3个月对参与者（n = 140）进行随访。病毒学和临床复发定义为病毒DNA水平> 2000 IU / mL，丙氨酸转氨酶（ALT）水平> 80 U / mL。随时间变化的Cox分析评估了随时间变化的HBsAg水平与复发的关系。
结果：

在中位随访19.9（四分位间距[IQR]，10.6-25.3）个月期间，94和49名患者发生了病毒学和临床复发，两年累计发生率为79.2％（95％置信区间[CI] ，70.9％-86.4％和42.9％（95％CI，34.1％-52.8％）。血清HBsAg水平以剂量反应方式与病毒学复发（P <0.001）和临床（P = 0.01）复发有关，调整危险比为2.10（95％CI，1.45-3.04）和2.32（95％CI ，1.28-4.21）。其中HBsAg水平低于10 IU / mL的患者（n = 19）中，只有1例和3例患者随后出现临床和病毒学复发。
结论：

在治疗结束时观察到的HBsAg血清梯度与停止NA治疗的慢性乙型肝炎患者随后出现的病毒学和临床复发有关。
关键词：

慢性乙型肝炎;乙肝表面抗原定量; Nucleos（t）ide类似物;时间依赖的Cox比例危害模型

结论：
    29221441
DOI：
    10.1186 / s12876-017-0697-3

StephenW

https://bmcgastroenterol.biomedc ... 6/s12876-017-0697-3