AASLD2018[458B]HBsAg消失之前的HBsAg动力学 在Hbeag-停止恩替卡韦治

StephenW

458B
HBsAg Kinetics Prior to HBsAg Loss after
Cessation of Entecavir Therapy in Hbeag-
Negative Chronic Hepatitis B Patients
Wen-Juei Jeng, Department of Gastroenterology and
Hepatology, Chang Gung Medical Foundation, Ming-Ling
Chang, College of Medicine, Chang Gung University;
Department of Gastroenterology and Hepatology, Chang
Gung Memorial Hospital, Linkou and Yun-Fan Liaw, Liver
Research Unit, Chang Gung Memorial Hospital
Background: Increasing evidence has shown that cessation
of nucleos(t)ide analogue (Nuc) therapy may increase HBsAg
seroclearance in HBeAg negative patients. End of treatment
(EOT) HBsAg<100 IU/mL and no re-treatment in patients with
sustained response and those with clinical relapse are two of
the strongest factors for subsequent HBsAg loss. However,
the HBsAg kinetics from EOT to HBsAg seroclearance is
unknown. The aim of the study is to investigate and compare
the HBsAg kinetics prior to HBsAg loss in these patients.
Methods: Among the 571 HBeAg negative patients who
stopped entecavir therapy, 26 patients with sustained
response (SR group) and 11 patients with clinical relapse
without retreatment (CR group) had achieved HBsAg loss
and had serial serum quantitative HBsAg (qHBsAg) data
till HBsAg seroclearance. They were included in this study.
Factors including age, gender, cirrhosis, hepatic steatosis,
treatment duration, qHBsAg at EOT and time to the start
of “precipitous HBsAg decline” (defined as > 0.5 log10IU/ml
in 1 year) were included in the analyses. Results: SR and
CR group had comparable age, gender, cirrhosis, fatty liver,
treatment duration, viral genotype while EOT qHBsAg was
significantly lower in the SR group [60 (0.6-817) vs. 355
(50-1914) IU/ml, P=0.005]. Both group showed successive
decrease of qHBsAg and then “precipitous HBsAg decline”
prior to HBsAg loss. SR group acheived HBsAg loss sooner
than the CR group (29 vs 54 months, P=0.016). The time from
EOT to the start of “precipitous HBsAg decline” was similar
in both groups, the HBsAg level at the start of “precipitous
HBsAg decline” was much lower in SR group (42.3 (0.6-766)
vs. 326 (26.5-1920) IU/ml, P=0.0068) while the decline slope
in SR group was only slightly greater (-1.29 log10IU/ml per
year vs. -1.01 log10IU/ml per year, P=0.7146). The time from
that point of start to HBsAg loss was shorter in SR group (23.8
vs. 39.5 months, P=0.012). Of the 11 patients in CR group, 9
showed “precipitous HBsAg decline” prior to clinical relapse
and the remaining 2 and one of the 9 patients showed superprecipitous
decline (> 1 log10 decline/year) following clinical
relapse. Conclusion: Both SR and CR groups patients
showed similar HBsAg kinetic of successive decline followed
by a “precipitous HBsAg decline” prior to HBsAg loss. The
lower EOT qHBsAg in SR group may be indicative of better
immune control and hence followed by sooner and uneventful
HBsAg loss.

StephenW

458B
HBsAg消失之前的HBsAg动力学
在Hbeag-停止恩替卡韦治疗
负性慢性乙型肝炎患者
Jang-Juei Jeng，胃肠病学系
肝病学，长庚医学基金会，明灵
Chang，长庚大学医学院;
张氏胃肠病学与肝病学系
林口耿纪念医院和肝韵韵
长庚纪念医院研究室
背景：越来越多的证据表明戒烟
核苷（酸）类似物（Nuc）治疗可能会增加HBsAg
HBeAg阴性患者的血清清除率。治疗结束
（EOT）HBsAg <100 IU / mL且无患者再次治疗
持续的反应和临床复发的是两个
后续HBsAg丢失的最强因素。然而，
从EOT到HBsAg血清清除的HBsAg动力学是
未知。该研究的目的是调查和比较
这些患者HBsAg丢失前的HBsAg动力学。
方法：571名HBeAg阴性患者中
停用恩替卡韦治疗，26例持续性
反应（SR组）和11例临床复发患者
未经复治（CR组）已达到HBsAg损失
并具有系列血清定量HBsAg（qHBsAg）数据
直到HBsAg血清清除。他们被纳入本研究。
包括年龄，性别，肝硬化，肝脏脂肪变性在内的因素，
治疗持续时间，EOT时的qHBsAg和开始时间
“急性HBsAg下降”（定义为> 0.5 log10IU / ml
在1年内）被包括在分析中。结果：SR和
CR组年龄，性别，肝硬化，脂肪肝，
治疗时间，病毒基因型，而EOT qHBsAg为
SR组显着降低[60（0.6-817）vs. 355
（50-1914）IU / ml，P = 0.005]。两组都连续出现
qHBsAg减少，然后“急性HBsAg下降”
在HBsAg丢失之前。 SR组更快地实现了HBsAg的丧失
比CR组（29对54个月，P = 0.016）。时间从
EOT到“急剧HBsAg下降”的开始是类似的
在两组中，HBsAg水平开始时“陡然
SR组HBsAg下降“低得多（42.3（0.6-766））
与326（26.5-1920）IU / ml，P = 0.0068）同时下降斜率
在SR组中仅稍高（-1.29 log10IU / ml /
年与-1.01 log10IU / ml /年，P = 0.7146）。时间从
SR组的HBsAg损失开始时间较短（23.8
对比39.5个月，P = 0.012）。 CR组11例，9例
在临床复发前显示“急性HBsAg下降”
剩下的2名患者和9名患者中的一名表现出超级倾向性
临床后下降（> 1 log10下降/年）
复发。结论：SR和CR组均为患者
显示出类似的HBsAg动力学随后连续下降
在HBsAg丧失之前，“急剧的HBsAg下降”。该
SR组中较低的EOT qHBsAg可能表示更好
免疫控制，因此更快和平安
HBsAg丢失。