治疗结束时HBsAg水平可预测慢性乙型肝炎中HBV复发

StephenW

Virginia Schad, PharmD
March 28, 2018
End-of-Treatment HBsAg Levels May Predict HBV Relapse in Chronic Hepatitis B


End-of-treatment HBsAg levels may be a clinically useful biomarker to predict HBV relapse in patients with chronic hepatitis B. End-of-treatment HBsAg levels may be a clinically useful biomarker to predict HBV relapse in patients with chronic hepatitis B.

Hepatitis B surface antigen (HBsAg) levels after stopping tenofovir disoproxil fumarate (TDF) therapy may be useful for predicting hepatitis B virus (HBV) relapse in patients with hepatitis B e antigen (HBeAg)-positive and HBeAg-negative chronic hepatitis B, according to a retrospective study published in the Journal of Viral Hepatitis.

Researchers enrolled 143 patients with chronic hepatitis B without cirrhosis, 39 of whom were HBeAg-positive and 104 of whom were HBeAg-negative, who had previously been treated with TDF and were followed posttreatment for at least 6 months. They found that the 104-week cumulative incidences of virological and clinical relapse in HBeAg-negative patients were 72.3% and 55.9%, respectively, and 66.6% and 59.1% in HBeAg-positive patients, respectively.

Further analyses revealed that the higher end-of-treatment HBsAg levels were an independent factor of virological relapse in HBeAg-positive and HBeAg-negative patients. The researchers found that the virological relapse rate at 78 weeks was 14.3% in HBeAg-positive patients who achieved an HBsAg level of 200 IU/mL or less and 19.6% in HBeAg-in HBeAg-negative patients who achieved an HBsAg level of 80 IU/mL or less. Of the 70 patients who developed clinical relapse, only 47 patients needed retreatment after TDF therapy discontinuation.

Although clinical relapse after stopping treatment with TDF tended to be early, the rate of developing hepatitis decompensation was rare, and none of the patients died after timely retreatment. The cumulative rate of HBsAg loss at 104 weeks was 45.5% and 59.3% in patients with end-of-treatment HBsAg levels of 80 IU/mL or less and 50 IU/mL or less, respectively.


The authors concluded that "end-of-treatment HBsAg levels of 200 and 80 IU/mL could predict HBV relapse in HBeAg-positive and HBeAg-negative patients, respectively." In addition, the incidence of HBsAg loss after stopping treatment with TDF was not rare in patients who achieved low end-of-treatment HBsAg levels.
Reference

Chen C-H, Hsu Y-C, Lu S-N, et al. The incidence and predictors of HBV relapse after cessation of tenofovir therapy in chronic hepatitis B patients [Published online December 23, 2017]. J Viral Hepat. doi: 10.1111/jvh.12851

StephenW

Virginia Schad，PharmD
2018年3月28日
治疗结束时HBsAg水平可预测慢性乙型肝炎中HBV复发


治疗结束时HBsAg水平可能是临床上有用的预测慢性乙型肝炎患者HBV复发的生物标志物。治疗结束时HBsAg水平可能是临床上有用的预测慢性乙型肝炎患者HBV复发的生物标志物。

根据乙型肝炎e抗原（HBeAg）阳性和HBeAg阴性慢性乙型肝炎患者停用替诺福韦二富马酸（TDF）治疗后的乙型肝炎表面抗原（HBsAg）水平可能有助于预测乙型肝炎病毒（HBV）复发发表在“病毒性肝炎杂志”上的回顾性研究。

研究人员招募了143名无肝硬化的慢性乙型肝炎患者，其中39名HBeAg阳性，其中104名HBeAg阴性，曾接受过TDF治疗并接受至少6个月的治疗。他们发现，HBeAg阴性患者104周累计病毒学和临床复发率分别为72.3％和55.9％，分别为66.6％和59.1％。

进一步分析显示，HBeAg阳性和HBeAg阴性患者HBsAg水平较高是治疗后病毒复发的独立因素。研究人员发现，HBeAg阳性患者在78周时的病毒学复发率为14.3％，HBeAg阴性患者HBsAg水平为80 IU时HBsAg水平为200 IU / mL或更低，HBeAg为19.6％ / mL以下。在70例发生临床复发的患者中，仅有47例患者在TDF治疗终止后需要再次治疗。

虽然停用TDF治疗后临床复发倾向于提早，但肝功能失代偿的发生率很少，并且没有一例患者在及时复治后死亡。治疗结束时HBsAg水平分别为80 IU / mL或更低和50 IU / mL或更低的患者在104周时的HBsAg消失累积率为45.5％和59.3％。


作者总结说：“治疗结束时HBsAg水平分别为200和80 IU / mL可以预测HBeAg阳性和HBeAg阴性患者的HBV复发。”此外，停用TDF治疗后HBsAg消失的发生率在达到治疗结束时HBsAg水平低的患者中并不罕见。
参考

陈C-H，许-，，吕思恩，等。慢性乙型肝炎患者停用替诺福韦治疗后HBV复发的发生率和预测因子[2017年12月23日在线发表]。 J Viral Hepat。 doi：10.1111 / jvh.12851

Hepbest

研究人员招募了143名无肝硬化的慢性乙型肝炎患者，其中39名HBeAg阳性，其中104名HBeAg阴性，曾接受过TDF治疗并接受至少6个月的治疗。他们发现HBeAg阴性患者104周累计病毒学和临床复发率分别为72.3％和55.9％
HBeAg阳性患者分别为66.6％和59.1％。

进一步分析显示，HBeAg阳性和HBeAg阴性患者HBsAg水平较高是治疗后病毒复发的独立因素。
研究人员发现，HBeAg阳性患者的HBsAg水平为200 IU / mL或更低时，78周时的病毒学复发率为14.3％
HBeAg阴性患者HBeAg阴性患者的HBsAg水平为80 IU / mL或更低，为19.6％。
在70例发生临床复发的患者中，仅有47例患者在TDF治疗终止后需要再次治疗。

虽然停用TDF治疗后临床复发倾向于提早，但肝功能失代偿的发生率很少，并且没有一例患者在及时复治后死亡。
治疗结束时HBsAg水平分别为80 IU / mL或更低和50 IU / mL或更低的患者在104周时的HBsAg消失累积率为45.5％和59.3％。


作者总结说：“治疗结束时HBsAg水平分别为200IU / mL的HBeAg阳性和80 IU / mL的HBeAg阴性可以预测和患者的HBV复发。” 此外，停用TDF治疗后HBsAg消失的发生率在达到治疗结束时HBsAg水平低的患者中并不罕见。