AASLD2018[399]肝炎的早期定量反应 B表面抗原与之相关 慢性乙型

StephenW

399
Early Quantitative Response of Hepatitis
B Surface Antigen Is Associated with
Seroclearance in Patients with Chronic
Hepatitis B during Nucleot(s)Ide Analog
Therapy
Murata Ayato1, Takuya Genda1, Sho Sato1, Nozomi Amano1,
Hironori Tsuzura1, Ko Tomishima1, Shunsuke Sato1, Kohei
Matsumoto1, Yuji Shimada1, Masashi Mori2 and Katsuyori
Iijima1, (1)Juntendo University Shizuoka Hospital, (2)
Fujinomiya City General Hospital
Background: Seroclearance of hepatitis B surface antigen
(HBsAg) is considered to be associated with favorable clinical
outcomes, and is thought to be an ideal end point of therapy
in patients with chronic hepatitis B (CHB). Till date, oral
administration of nucleot(s)ide analogues (NAs) has been
the most popular treatment strategy for patients with CHB
because of their excellent virologic efficacy and safety profile.
Long-term administration of NAs suppresses hepatitis B
virus replication in >95% of patients, resulting in biochemical
remission and histological improvement, including the
regression of cirrhosis. However, HBsAg seroclearance is
a rare event even with NA therapy, and factors associated
with HBsAg seroclearance have not been fully clarified. The
present study aimed to clarify the dynamics of quantitative
serum HBsAg levels and its association with HBsAg
seroclearance, in patients with CHB who received NA therapy.
Methods: This study retrospectively included 160 patients
with CHB who received NA therapy, between 2003 and 2015
at our hospital. Serum HBsAg levels were serially quantified
before and during treatment. Early response of serum
HBsAg level was estimated as the percentage of HBsAg
decline at 48 weeks after NA therapy initiation. Cumulative
incidences of HBsAg seroclearance were evaluated using
the Kaplan-Meier plot analysis and the log-rank test. The
factors associated with HBsAg seroclearance were analyzed
by Cox proportional hazards analysis. Results: During the
median follow-up time of 7.6 years (range: 1.1–13.1 years),
HBsAg seroclearance was observed in 6 of the 160 patients
(1.8%/7 years). Age > 65 years and early HBsAg response >
85% were identified as factors significantly associated with
HBsAg seroclearance. Early HBsAg response > 85% was
observed in 11 of 160 patients (6.9%). The 7-year cumulative
incidences of HBsAg seroclearance was 28.6% and 0.0% in
patients with and without early HBsAg response, respectively
(p < 0.001). Conclusion: Both age and early HBsAg
response were significant predictors of HBsAg seroclearance
in CHB patients during NA therapy. Early HBsAg response
can be considered as an alternative treatment target instead
of HBsAg seroclearance, in patients with CHB during NA
therapy.

StephenW

399
肝炎的早期定量反应
B表面抗原与之相关
慢性乙型肝炎患者的血清清除率
Nucleot（s）Ide Analog期间的乙型肝炎
治疗
Murata Ayato1，Takuy​​a Genda1，Sho Sato1，Nozomi Amano1，
Hironori Tsuzura1，Ko Tomishima1，Shunsuke Sato1，Kohei
Matsumoto1，Yuji Shimada1，Masashi Mori2和Katsuyori
Iijima1，（1）顺天大学静冈医院，（2）
富士宫市综合医院
背景：乙型肝炎表面抗原的血清清除率
（HBsAg）被认为与有利的临床相关
结果，被认为是理想的治疗终点
在慢性乙型肝炎（CHB）患者中。直到约会，口头
已经给予核苷酸类似物（NAs）
CHB患者最常用的治疗策略
因为它们具有优异的病毒学效力和安全性。
长期服用NAs可抑制乙型肝炎
病毒复制> 95％的患者，导致生化
缓解和组织学改善，包括
肝硬化消退。但是，HBsAg血清清除是
即使是NA治疗也是罕见的事件，也是相关因素
有HBsAg血清清除尚未完全澄清。该
目前的研究旨在澄清定量动力学
血清HBsAg水平及其与HBsAg的关系
血清清除，接受NA治疗的CHB患者。
方法：本研究回顾性分析160例患者
在2003年至2015年期间接受NA治疗的CHB患者
在我们医院。血清HBsAg水平连续定量
治疗前和治疗期间。血清早期反应
HBsAg水平估计为HBsAg的百分比
NA治疗开始后48周下降。累积的
HBsAg血清清除的发生率用
Kaplan-Meier图分析和对数秩检验。该
分析了与HBsAg血清清除相关的因素
通过Cox比例风险分析。结果：期间
中位随访时间为7。6年（范围：1.1-13.1岁），
在160名患者中的6名中观察到HBsAg血清清除率
（1.8％/ 7年）。年龄> 65岁，早期HBsAg反应>
85％被确定为与其显着相关的因素
HBsAg血清清除率。早期HBsAg反应> 85％
在160名患者中的11名（6.9％）中观察到。 7年累计
HBsAg血清清除率为28.6％和0.0％
有和没有早期HBsAg反应的患者，分别
（p <0.001）。结论：年龄和早期HBsAg
反应是HBsAg血清清除的重要预测因子
在NA治疗期间CHB患者。早期HBsAg反应
可以被视为替代治疗目标
在NA期间CHB患者中HBsAg血清清除率的变化
治疗。