AASLD2018[397]乙型肝炎核心相关抗原与小说 B级评分预测复发风

StephenW

397
Hepatitis B Core-Related Antigen and the Novel
Scale-B Score to Predict Relapse Risk after
Cessation of Nucleos(t)Ide Analogs in Patients
with Chronic Hepatitis B
Yao-Chun Hsu1, Mindie H. Nguyen2, Lien-Juei Mou3, Ming-
Shiang Wu4, Tzeng-Huey Yang5, Chieh-Chang Chen4,
Cheng-Hao Tseng6, Chi-Ming Tai6, Chun-Ying Wu7, Jaw-
Town Lin8, Yasuhito Tanaka9 and Chi-Yang Chang8, (1)I-Shou
University, (2)Division of Gastroenterology and Hepatology,
Stanford University Medical Center, (3)Tainan Municipal
Hospital, (4)National Taiwan University Hospital, (5)Lotung
Poh-Ai Hospital, (6)E-Da Hospital, (7)Taipei Veterans General
Hospital, (8)Fu-Jen Catholic University Hospital, (9)Nagoya
City University
Background: The risk of clinical flare and the chance
of hepatitis B surface antigen (HBsAg) loss are major
considerations for a finite nucleos(t)ide analogue (NA) therapy
in patients with chronic hepatitis B (CHB). We aimed to develop
a risk score to predict clinical flare and HBsAg loss after NA
cessation. Methods: This prospective multicenter study
enrolled 135 CHB patients who stopped entecavir or tenofovir
after being treated for at least 3 years with viral remission
for a median of 25.2 months. All patients were serologically
HBeAg-negative without detectable viral DNA at NA cessation.
Study outcomes were clinical relapse and HBsAg loss. Risk
predictors including serum HBsAg and hepatitis B corerelated
antigen (HBcrAg) levels were explored using Cox
proportional hazard model and weighted by their regression
coefficients to develop a scoring system. Results: During a
median follow-up of 25.9 months, clinical relapse and HBsAg
loss occurred in 66 and 8 patients, respectively, with a 5-year
cumulative incidence of 56.14% (95% CI, 46.71-66.00%)
and 8.75% (95% CI, 4.30-17.37%), respectively. HBsAg,
HBcrAg, age, ALT, and tenofovir use were independent risk
factors. The SCALE-B score was calculated by the equation:
35*HBsAg (log IU/mL) + 20*HBcrAg (log U/mL) + 2*age (year)
+ ALT (U/L) + 40 for tenofovir use. The Harrell’s c indices of
the score for clinical relapse were 0.87, 0.88, 0.87, 0.85, and
0.90 at 1, 2, 3, 4, and 5 years, respectively. Moreover, HBsAg
seroclearance exclusively occurred in the low-risk patients
according to the SCALE-B score. Conclusion: The novel
SCALE-B score based on serum levels of HBsAg, HBcrAg,
age, ALT, and tenofovir use can predict clinical relapse and
HBsAg loss after cessation of entecavir or tenofovir in patients
with CHB.

StephenW

397
乙型肝炎核心相关抗原与小说
B级评分预测复发风险
在患者中停止核（t）Ide类似物
与慢性乙型肝炎
Yao-Chun Hsu1，Mindie H. Nguyen2，Lien-Juei Mou3，Ming-
Shiang Wu4，Tzeng-Huey Yang5，Chieh-Chang Chen4，
程承昊6，Chi-Ming Tai6，吴春英7，Jaw-
Town Lin8，Yasuhito Tanaka9和Chi-Yang Chang8，（1）I-Shou
大学，（2）消化内科和肝病学科，
斯坦福大学医学中心，（3）台南市
医院，（4）国立台湾大学医院，（5）Lotung
Poh-Ai医院，（6）E-Da医院，（7）台北退伍军人将军
医院，（8）辅仁天主教大学医院，（9）名古屋
城市大学
背景：临床发作的风险和机会
乙型肝炎表面抗原（HBsAg）损失是主要的
有限核（t）ide类似物（NA）治疗的考虑因素
在慢性乙型肝炎（CHB）患者中。我们的目标是发展
预测NA后临床眩光和HBsAg消失的风险评分
戒烟。方法：这项前瞻性多中心研究
招募了135名停用恩替卡韦或替诺福韦的CHB患者
经病毒缓解治疗至少3年后
中位数为25.2个月。所有患者均为血清学
在NA停止时HBeAg阴性，没有可检测的病毒DNA。
研究结果是临床复发和HBsAg消失。风险
预测因子包括血清HBsAg和乙型肝炎核心相关
使用Cox探索抗原（HBcrAg）水平
比例风险模型，并通过回归加权
系数来开发评分系统。结果：在一个
中位随访25.9个月，临床复发和HBsAg
分别为66例和8例患者，分别为5年
累计发病率为56.14％（95％CI，46.71-66.00％）
和8.75％（95％CI，4.30-17.37％）。乙肝表面抗原，
HBcrAg，年龄，ALT和替诺福韦的使用是独立的风险
因素。 SCALE-B得分通过以下公式计算：
35 * HBsAg（log IU / mL）+ 20 * HBcrAg（log U / mL）+ 2 *年龄（年）
替诺福韦使用+ ALT（U / L）+ 40。哈雷尔的c指数
临床复发评分分别为0.87,0.88,0.87,0.85和
在1年，2年，3年，4年和5年分别为0.90。而且，HBsAg
血清清除仅发生在低风险患者身上
根据SCALE-B得分。结论：小说
SCALE-B评分基于血清HBsAg水平，HBcrAg，
年龄，ALT和替诺福韦的使用可以预测临床复发和
停用恩替卡韦或替诺福韦后患者HBsAg消失
与CHB。