慢性HBV感染中HBsAg血清清除率低

StephenW

Virginia Schad, PharmD
November 12, 2018
Low Rates of HBsAg Seroclearance in Chronic HBV Infection

Low rates of HBsAg seroclearance were found in untreated and treated patients with chronic hepatitis B infection. Low rates of HBsAg seroclearance were found in untreated and treated patients with chronic hepatitis B infection.

Patients with chronic hepatitis B virus (HBV) infection should receive lifelong treatment because of the very low incidence rates of hepatitis B surface antigen (HBsAg) seroclearance regardless of treatment, according to a systematic review and meta-analysis published in Gastroenterology.1

Patients who have chronic HBV infection are at risk of developing cirrhosis and hepatocellular carcinoma, and although curative therapies are not available for chronic HBV, the therapeutic goal is to achieve functional cure.2

Reported annual HBsAg seroclearance rates are currently low with available treatments; therefore, researchers analyzed 34 published studies with 42,588 patients and 303,754 person-years of follow-up to provide a more precise estimate of HBsAg seroprevalence rates among subgroups and populations.1,2 They found that the pooled annual rate of HBsAg seroclearance was 1.02%, and cumulative incidence rates were 4.03% at 5 years, 8.16% at 10 years, and 17.99% at 15 years.

Seroclearance occurred mainly in patients with less active disease, with a higher proportion of patients achieving seroclearance who were negative for hepatitis B e antigen (HBeAg) at baseline than patients who were HBeAg positive at baseline (1.33% vs 0.40%; P <.01).

Patients with low levels of HBV DNA and low quantitative HBsAg levels at baseline were also more likely to achieve HBsAg seroclearance than patients with higher levels of HBV DNA and HBsAg (P <.01). HBV genotype or treatment history with available oral antiviral therapy did not seem to have a substantial effect on HBsAg seroclearance.



"In conclusion, in this systematic review and meta-analysis, we determined that the incident rate of HBsAg seroclearance was a rare event such that by year 15 after study entry, less than 20% of patients had cleared HBsAg," stated the authors.1 Thus, "patients with chronic HBV infection should therefore be counseled on the need for lifelong treatment, and curative therapies are needed."

StephenW

Virginia Schad，PharmD
2018年11月12日
慢性HBV感染中HBsAg血清清除率低

在未治疗和治疗的慢性乙型肝炎感染患者中发现HBsAg血清清除率低。在未治疗和治疗的慢性乙型肝炎感染患者中发现HBsAg血清清除率低。

慢性乙型肝炎病毒（HBV）感染患者应接受终身治疗，因为无论治疗如何，乙型肝炎表面抗原（HBsAg）血清清除的发生率非常低，根据胃肠病学发表的系统评价和荟萃分析。

患有慢性HBV感染的患者有发展为肝硬化和肝细胞癌的风险，虽然慢性HBV没有治愈性疗法，但治疗目标是实现功能性治愈.2

报告的年度HBsAg血清清除率目前较低，可用治疗方法;因此，研究人员分析了34项已发表的研究，共42,588名患者和303,754人年的随访，以便更准确地估计亚组和人群中HBsAg的血清阳性率.1,2他们发现HBsAg血清阳性率的汇总年率为1.02％ ，累计发病率在5年时为4.03％，10年时为8.16％，15年时为17.99％。

血清清除主要发生在疾病活动较少的患者中，基线时乙型肝炎e抗原（HBeAg）阴性的患者比例高于基线时HBeAg阳性的患者（1.33％vs 0.40％; P <.01 ）。

HBV DNA水平低且基线HBsAg水平低的患者比HBV DNA和HBsAg水平较高的患者更容易出现HBsAg血清清除（P <.01）。可用口服抗病毒治疗的HBV基因型或治疗史似乎对HBsAg血清清除没有实质性影响。



“总之，在这项系统评价和荟萃分析中，我们确定HBsAg血清清除的发生率是一种罕见的事件，因此在研究开始后到第15年，只有不到20％的患者清除了HBsAg，”作者说。因此，“因此，应该建议患有慢性HBV感染的患者需要终身治疗，并且需要治疗。”

纠结哥哥

丙肝现在能治愈了  治愈后肝硬化患癌风险高吗

StephenW

回复 纠结哥哥 的帖子

治愈后肝硬化患癌减少.

Patients with advanced fibrosis or cirrhosis prior to antiviral treatment will have decreased but persistent risk of hepatocellular carcinoma following cure of hepatitis C.
在抗病毒治疗之前患有晚期纤维化或肝硬化的患者在治愈丙型肝炎后肝细胞癌的风险会降低但持续存在。

纠结哥哥

丙肝概率会有多少呢？如果乙肝早期肝硬化治愈后，HCC风险高吗？应该很低很低很低了吧

SK蜗牛

回复 纠结哥哥 的帖子

几乎概率和常人一样

StephenW

回复 纠结哥哥 的帖子

HCC是由多因素引起的，需要时间来开发，很难评估风险。 我个人认为，对于乙型肝炎患者，避免严重的纤维化/肝硬化.

2015年4月
Risk of hepatocellular carcinoma in chronic hepatitis B: Assessment and modification with current antiviral therapy

Using only studies reporting comparative data with vs. without NA treatment, all of which were from Asia, treatment with a current NA resulted in a significant reduction of HCC risk by ∼30% in cirrhotic patients, and by ∼80% in non-cirrhotic patients.
仅使用报告比较数据与非NA治疗的比较数据，所有这些都来自亚洲，当前NA治疗导致肝硬化患者HCC风险显着降低~30％，非肝硬化患者降低~80％ 。

纠结哥哥

就是早期肝硬化或者中度肝纤维化 以后乙肝合一壳出来后，HCV几率和常人一样?