依从性差是导致慢性乙型肝炎患者病毒突破的原因之一

StephenW

Poor adherence is a contributor to viral breakthrough in patients with chronic hepatitis B
         

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Authors Wang L, Chen P, Zheng C

Received 6 September 2018

Accepted for publication 28 September 2018

Published 8 November 2018 Volume 2018:11 Pages 2179—2185

DOI https://doi.org/10.2147/IDR.S186719

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Professor Suresh Antony

Liguo Wang,1,* Peng Chen,2,* Chao Zheng3

1Department of Infectious Diseases, First Affiliated Hospital of Xiamen University, Fujian Province, China; 2Department of Emergency, Xinglin Hospital, First Affiliated Hospital of Xiamen University, Fujian Province, China; 3Department of Respiratory, First Affiliated Hospital of Xiamen University, Fujian Province, China

*These authors contributed equally to this work

Objective: The objective of this study was to explore the risk factors of poor adherence of nucleoside analogs (NUC) treatment in chronic hepatitis B (CHB) patients and the virological changes in patients with poor adherence.
Subjects and methods: A total of 205 CHB patients were enrolled. The patients’ demographic data and family history were collected. NUC adherence was calculated every 12 weeks as follows: number of NUC tablets taken by the patients was divided by the number of NUC tablets prescribed. NUC adherence > 90% was defined as good adherence of NUC treatment.
Results: NUC adherence of male patients was significantly lower than that of female patients. Adherence among patients with previous NUC treatment was poorer than that of patients without previous NUC treatment. Multivariate analysis indicated that female gender (OR =0.367, P=0.013) was the protective factor for NUC adherence in CHB patients, while pretreatment with NUC was the risk factor for NUC adherence (OR =3.209, P=0.002). A total of six patients in the good adherence group experienced virological breakthroughs while 15 of 77 patients in the poor adherence group experienced virological breakthroughs (P=0.001). Similar trends were observed in NUC resistance. Four of the 128 patients with good adherence developed NUC resistance while nine of the 77 patients with poor adherence developed resistance (P=0.015). Multivariate analysis suggested that pretreatment with NUC (OR =3.133, P=0.031), NUC drugs (OR = 3.951, P=0.010), and adherence (OR =2.749, P=0.046) were independent risk factors associated with virological breakthroughs and that NUC drugs (OR =7.083, P=0.005) and poor adherence (OR =4.951, P=0.009) were independent risk factors for NUC resistance.
Conclusion: Male gender and pretreatment with NUC were risk factors associated with NUC adherence. Poor NUC adherence is more likely to induce virological breakthroughs and NUC resistance. For patients with poor NUC adherence, it is necessary to give timely education to improve treatment adherence.

Keywords: chronic hepatitis B, adherence, nucleoside analogs, virological breakthroughs, risk factors

StephenW

依从性差是导致慢性乙型肝炎患者病毒突破的原因之一
         

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作者王莉，陈丕，郑C

2018年9月6日收到

已接受发布于2018年9月28日

2018年11月8日出版卷2018：11页2179-2185

DOI https://doi.org/10.2147/IDR.S186719

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批准出版的编辑：Suresh Antony教授

李立国，1，*陈鹏，2，*赵正3

1福建省厦门大学第一附属医院感染科1; 2福建省厦门大学第一附属医院杏林医院急诊科;厦门大学附属第一医院呼吸科，福建省

*这些作者同等贡献这项工作

目的：本研究的目的是探讨慢性乙型肝炎（CHB）患者核苷类似物（NUC）治疗依从性差的危险因素以及依从性差的患者的病毒学变化。
受试者和方法：共招募了205名CHB患者。收集患者的人口统计数据和家族史。如下每12周计算NUC依从性：患者服用的NUC片剂的数量除以处方的NUC片剂的数量。 NUC依从性> 90％被定义为NUC治疗的良好依从性。
结果：男性患者的NUC依从性显着低于女性患者。先前NUC治疗的患者的依从性比没有NUC治疗的患者更差。多变量分析表明，女性性别（OR = 0.367，P = 0.013）是CHB患者NUC依从性的保护因素，而NUC预处理是NUC依从性的危险因素（OR = 3.209，P = 0.002）。良好依从性组中共有6名患者经历了病毒学突破，而依从性差组中的77名患者中有15名经历了病毒学突破（P = 0.001）。在NUC抗性中观察到类似的趋势。 128名具有良好依从性的患者中有4名发生了NUC耐药，而77名依从性差的患者中有9名产生了耐药性（P = 0.015）。多变量分析表明，NUC预处理（OR = 3.133，P = 0.031），NUC药物（OR = 3.951，P = 0.010）和依从性（OR = 2.749，P = 0.046）是与病毒学突破相关的独立危险因素。 NUC药物（OR = 7.083，P = 0.005）和不良依从性（OR = 4.951，P = 0.009）是NUC耐药的独立危险因素。
结论：男性性别和NUC预处理是与NUC依从性相关的危险因素。较差的NUC依从性更可能诱导病毒学突破和NUC抗性。对于NUC依从性差的患者，有必要及时接受教育以提高治疗依从性。

关键词：慢性乙型肝炎，依从性，核苷类似物，病毒学突破，危险因素

StephenW

https://www.dovepress.com/getfile.php?fileID=45992

hao12168

在中国，女性自愈率都很高，