NA停药后的HBV抗体水平预测复发风险

StephenW

HBV antibody levels after NA discontinuation predict relapse risk

Chi H, et al. Clin Gastroenterol Hepatol. 2018;doi:10.1016/j.cgh.2018.05.047.
July 9, 2018

Discontinuation of nucleos(t)ide analogue therapy for chronic hepatitis B correlated with risk for clinical relapse based on total serum level of HBV core antibodies after 2.5 years of follow-up, according to recently published data.

“Studies have suggested that the recognition and targeting of [HBV core antibodies (anti-HBc)] by the adaptive immune system play an important role in viral clearance,” Heng Chi, MD, from the Erasmus MC University Medical Center in Rotterdam, the Netherlands, and colleagues wrote. “Our results suggest that a high level of anti-HBc may be correlated with a more enhanced HBV-specific immune response.”


The study comprised 100 patients who were positive for HBV surface antigen, negative for HBV e-antigen, and had undetectable HBV DNA at the time of nucleos(t)ide analogue (NA) discontinuation. During a median follow-up of 2.5 years, no patients developed decompensated cirrhosis or hepatocellular carcinoma.

During follow-up, 39 patients experienced clinical relapse and 76 patients experienced virologic relapse with HBV DNA higher than 2,000 IU/mL. Six patients experienced HBsAg seroclearance after NA discontinuation for a cumulative rate of 10% at year 4.

Multivariate analysis showed that younger age (HR = 1.06; 95% CI, 1.01-1.11), low end-of-treatment HBsAg levels (HR = 1.71; 95% CI, 1.05-2.81), and high end-of-treatment anti-HBc levels (HR = 0.31; 95% CI, 0.15-0.65) correlated significantly with a reduced risk for clinical relapse.

Further stratification of end-of-treatment anti-HBc levels showed that a level of 1,000 IU/mL or higher correlated with the lowest risk for clinical relapse (21% at year 4; P < .05) compared with levels between 100 IU/mL and 999 IU/mL (50% at year 4). In contrast, patients with anti-HBc levels less than 100 IU/mL had the highest risk for clinical relapse (85% at year 4; P < .05).

“Anti-HBc alone or in combination with HBsAg appear to play an important role in the selection of patients who are suitable for treatment discontinuation, and therefore warrant further validation,” the researchers concluded. – by Talitha Bennett

Disclosure: Chi reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

StephenW

NA停药后的HBV抗体水平可预测复发风险

Chi H，et al。 Clin Gastroenterol Hepatol。 2018; DOI：10.1016 / j.cgh.2018.05.047。
2018年7月9日

根据最近公布的数据，基于总血清HBV核心抗体水平，核苷（酸）类似物治疗中止慢性乙型肝炎与临床复发风险相关，为期2。5年的随访。

“研究表明，适应性免疫系统对[HBV核心抗体（抗-HBc）]的识别和靶向在病毒清除中起着重要作用，”来自鹿特丹Erasmus MC大学医学中心的Heng Chi Holland博士写道。路。 “我们的研究结果表明，高水平的抗HBc可能与更强的HBV特异性免疫反应有关。”

该研究包括100个HBV表面抗原阳性，HBV e抗原阴性，以及当核苷（酸）类似物（NA）被中断时未检测到HBV DNA的患者。在中位随访2。5年期间，没有患者出现失代偿性肝硬化或肝细胞癌。

在随访期间，39例患者出现临床复发，76例患者病毒复发，HBV DNA高于2,000 IU / mL。 NA停药后6例患者出现HBsAg血清清除率，第4年累计发生率为10％。

多变量分析显示年龄较小（HR = 1.06; 95％CI，1.01-1.11），治疗结束时HBsAg水平较低（HR = 1.71; 95％CI，1.05-2.81），治疗结束时间较长 - HBc水平（ HR = 0.31; 95％CI，0.15-0.65）与降低的临床复发风险显着相关。

治疗结束时抗-HBc水平的进一步分层显示出1,000 IU / mL或更高的水平，临床复发风险最低，与100 IU / 100之间的水平相比（4年内为21％; P <。05）相关。 mL和999 IU / mL（第4年为50％）。相反，抗-HBc水平低于100 IU / mL的患者临床复发风险最高（4年内为85％; P <.05）。

“单独使用抗HBc或与HBsAg联合使用似乎在选择有资格停止治疗的患者中发挥重要作用，因此需要进一步验证，”研究人员总结道。 - Talitha Bennett

披露：Chi报告没有相关的财务披露。有关其他作者的完整财务披露，请参阅完整的研究。

Hepbest

部分战友能够停药也是好事。

治疗结束时抗-HBc水平的进一步分层显示出1,000 IU / mL或更高的水平，临床复发风险最低，与100 IU / 100之间的水平相比（4年内为21％; P <。05）相关。 mL和999 IU / mL（第4年为50％）。相反，抗-HBc水平低于100 IU / mL的患者临床复发风险最高（4年内为85％; P <.05）。

“单独使用抗HBc或与HBsAg联合使用似乎在选择有资格停止治疗的患者中发挥重要作用，因此需要进一步验证，”

hao12168

对抗HBc的研究资料很少，1，3，5阳的常见，长期1，3阳的也有，但是问医生为什么抗HBc迟迟不阳性，医生回答不了，只笼统说一下1，3阳和1，3，5阳是一样的。
也有1，4，5阳性，DNA阴性患者，DNA中度反弹，5变成弱阳性，医生说是试剂问题。