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乙型肝炎表面抗原动力学在治疗初治慢性乙型肝炎患者长期 [复制链接]

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发表于 2018-2-22 13:55 |只看该作者 |倒序浏览 |打印
World J Gastroenterol. 2018 Feb 14;24(6):725-736. doi: 10.3748/wjg.v24.i6.725.
Clinical utility of hepatitis B surface antigen kinetics in treatment-naïve chronic hepatitis B patients during long-term entecavir therapy.Lin TC1, Chiu YC1, Chiu HC1, Liu WC2, Cheng PN1, Chen CY1, Chang TT1, Wu IC3.
Author information
1Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, 70403, Taiwan.2Infectious Disease and Signaling Research Center, National Cheng Kung University, Tainan 70403, Taiwan.3Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, 70403, Taiwan. [email protected].

AbstractAIM: To investigate the utility of hepatitis B surface antigen (HBsAg) kinetics in chronic hepatitis B patients during long-term entecavir treatment.
METHODS: This retrospective study included treatment-naïve chronic hepatitis B patients who received at least 2 years of consecutive entecavir treatment. Patients were followed up at three to six month intervals with liver biochemistry, hepatitis B virus DNA, and abdominal sonography. In hepatitis B e antigen (HBeAg)-positive patients, HBeAg levels were assessed every three to six month until results became negative. Serum HBsAg levels were determined at the baseline, one-year and five-year time points. Liver cirrhosis was diagnosed through liver biopsy, imaging examinations, or clinical findings of portal hypertension. Hepatocellular carcinoma was diagnosed by histological examination or dynamic image studies.
RESULTS: A total of 211 patients were enrolled. The median treatment time was 5.24 (2.00-9.62) years. Multivariate analysis showed that lower baseline HBsAg levels were associated with an earlier virological response, earlier hepatitis B e antigen (HBeAg) seroconversion, and earlier biochemical response in HBeAg-positive patients (cut-off value: 4 log IU/mL) and an earlier virological response in HBeAg-negative non-cirrhotic patients (cut-off value: 2.4 log IU/mL). Although HBsAg levels decreased slowly during long-term entecavir treatment, higher HBsAg decrease rates were found in the first year for HBeAg-positive non-cirrhotic patients, and patients with higher baseline HBsAg levels. More favorable clinical outcomes were not observed by a rapid HBsAg decline per se, but depended on lower baseline HBsAg levels.
CONCLUSION: Baseline HBsAg can be used to predict treatment responses. HBsAg levels and decrease rates should be considered together according to disease status while interpreting HBsAg changes.


KEYWORDS: Chronic hepatitis B; Entecavir; Hepatitis B e antigen; Hepatitis B surface antigen; Kinetics

PMID:29456411PMCID:PMC5807675DOI:10.3748/wjg.v24.i6.725

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才高八斗

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发表于 2018-2-22 13:56 |只看该作者
世界J Gastroenterol。 2018年2月14日; 24(6):725-736。 doi:10.3748 / wjg.v24.i6.725。
乙型肝炎表面抗原动力学在治疗初治慢性乙型肝炎患者长期恩替卡韦治疗期间的临床应用。
Lin TC1,Chiu YC1,Chiu HC1,Liu WC2,Cheng PN1,Chen CY1,Chang TT1,Wu IC3。
作者信息

1
    台湾省台南市成功大学医学院成功大学医院内科70403
2
    台湾台南70403成大学传染病与信号研究中心。
3
    台湾省台南市成功大学医学院成功大学医院内科70403 [email protected]

抽象
目标:

探讨长期恩替卡韦治疗期间乙肝表面抗原(HBsAg)动力学在慢性乙型肝炎患者中的应用。
方法:

这项回顾性研究包括接受至少2年连续恩替卡韦治疗的未接受治疗的慢性乙型肝炎患者。以肝生化,乙肝病毒DNA和腹部超声检查对患者进行3至6个月的随访。在乙型肝炎e抗原(HBeAg)阳性患者中,每三到六个月评估一次HBeAg水平,直到结果变为阴性。在基线,一年和五年时间点确定血清HBsAg水平。肝硬化通过肝活检,影像学检查或门静脉高压的临床表现来诊断。肝细胞癌通过组织学检查或动态图像研究诊断。
结果:

共有211名患者入选。中位治疗时间为5.24(2.00-9.62)年。多变量分析显示,较低的基线HBsAg水平与较早的病毒学应答,较早的乙肝e抗原(HBeAg)血清转换和较早的HBeAg阳性患者的生化反应(截断值:4log IU / mL)以及较早的HBeAg阴性非肝硬化患者的病毒学应答(截断值:2.4log IU / mL)。虽然长期恩替卡韦治疗期间HBsAg水平缓慢下降,但在HBeAg阳性非肝硬化患者和基线HBsAg水平较高的患者的第一年发现HBsAg下降率更高。更快的HBsAg下降本身没有观察到更有利的临床结果,但依赖于更低的基线HBsAg水平。
结论:

基线HBsAg可用于预测治疗反应。在解释HBsAg变化时,应根据疾病状态综合考虑HBsAg水平和降低率。
关键词:

慢性乙型肝炎;恩替卡韦;乙型肝炎e抗原;乙型肝炎表面抗原;动力学

结论:
    29456411
PMCID:
    PMC5807675
DOI:
    10.3748 / wjg.v24.i6.725

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才高八斗

3
发表于 2018-2-22 13:57 |只看该作者

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4
发表于 2018-2-24 15:58 |只看该作者
个人认为:第一年的免疫能力的作用和很明显,随着抗病毒的进行,免疫的能力越来越小,因而表抗降低也乏力
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心怀希望,那么就永远有希望
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5
发表于 2018-2-24 19:08 |只看该作者
学术讨论、关键是看不懂、强烈要求发文者能提炼一下、
身体及心理健康同等重要!
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