停用核苷（酸）类似物治疗慢性乙型肝炎患者后乙型肝炎表

StephenW

Hepatitis B surface antigen loss after discontinuing nucleos(t)ide analogue for treatment of chronic hepatitis B patients is persistent in White patients

Suárez, Emilioa; Buti, Maríac; Rodríguez, Manuelf; Prieto, Martíng; Pascasio-Acevedo, Juan M.b; Casanovas, Teresad; Crespo, Javieri; Tapiador, Juan Arenas Ruizj; Gómez-Rodríguez, Rafaelk; Figueruela, Blancaa; Diago, Moisésh; Morillas, Rosa M.e; Zozaya, José M.l; Calleja, José L.m; Casado, Martan; Molina, Esthero; Fuentes, Javierp; Simón, Miguel A.q
European Journal of Gastroenterology & Hepatology: February 2019 - Volume 31 - Issue 2 - p 267–271
doi: 10.1097/MEG.0000000000001289
Original Articles: Hepatology

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Objective The objective of this study was to determine the long-term clinical outcome and persistence of hepatitis B surface antigen (HBsAg) loss after discontinuation of treatment.

Background The prognosis of patients with chronic hepatitis B (CHB) treated with nucleos(t)ide analogues (NAs) who discontinue treatment after loss of HBsAg remains largely unknown, particularly in White patients.

Patients and methods We analysed a cohort of patients with CHB who discontinued NA treatment after loss of HBsAg. A total of 69 patients with hepatitis-B-e antigen-positive or hepatitis-B-e antigen-negative CHB with undetectable HBsAg during NA treatment were included after discontinuation of treatment, and followed up for a median period of 37.8 months (interquartile range: 23.8–54.6 months).

Results At the end of follow-up, none of the patients showed spontaneous reappearance of HBsAg and only one patient had detectable hepatitis B virus DNA (22 IU/ml). Another patient negative for HBsAg and anti-HBs developed hepatitis B virus reactivation without elevated transaminases after treatment with corticosteroids and vincristine for dendritic cell neoplasm, 38 months after withdrawal of the antiviral treatment. Regarding clinical outcome, a patient with cirrhosis developed hepatocellular carcinoma, 6.6 years after discontinuing treatment. None of the patients had hepatic decompensation or underwent liver transplantation.

Conclusion HBsAg clearance after discontinuing NAs in patients with CHB is persistent and associated with good prognosis. The risk for developing hepatocellular carcinoma persists among patients with cirrhosis.

StephenW

停用核苷（酸）类似物治疗慢性乙型肝炎患者后乙型肝炎表面抗原丢失在白人患者中持续存在

Suárez，Emilioa; Buti，Maríac; Rodríguez，Manuelf; Prieto，Martíng; Pascasio-Acevedo，Juan M.b; Casanovas，Teresad;克雷斯波，贾维里; Tapiador，Juan Arenas Ruizj; Gómez-Rodríguez，Rafaelk; Figueruela，Blancaa; Diago，Moisésh; Morillas，Rosa M.e; Zozaya，JoséM.; Calleja，JoséLm;卡萨多，马坦;莫利纳，Esthero; Fuentes，Javierp;西蒙，米格尔A.q
欧洲胃肠病学和肝病学杂志：2019年2月 - 第31卷 - 第2期 - 第267-271页
doi：10.1097 / MEG.0000000000001289
原创文章：肝脏病学

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目的本研究的目的是确定停止治疗后乙型肝炎表面抗原（HBsAg）丢失的长期临床结果和持续性。

背景：在HBsAg丧失后停止治疗的核苷（酸）类似物（NAs）治疗的慢性乙型肝炎（CHB）患者的预后仍然很大程度上未知，特别是在白人患者中。

患者和方法我们分析了一组患有CHB的患者，他们在HBsAg丧失后停止了NA治疗。在停止治疗期间共纳入69例肝炎-Be抗原阳性或肝炎-Be抗原阴性CHB并且在NA治疗期间检测不到HBsAg，并且随访中位时间为37.8个月（四分位数间距：23.8-54.6）个月）。

结果在随访结束时，没有患者表现出HBsAg的自发再现，只有一名患者有可检测到的乙型肝炎病毒DNA（22 IU / ml）。在停用抗病毒治疗38个月后，另一名HBsAg和抗HBs阴性的患者在用皮质类固醇和长春新碱治疗树突状细胞肿瘤后，转换酶升高而乙型肝炎病毒再次激活。关于临床结果，肝硬化患者在停止治疗后6。6年发展为肝细胞癌。没有患者出现肝功能失代偿或肝移植。

结论CHB患者停用NAs后HBsAg清除持续存在，预后良好。在患有肝硬化的患者中，患肝细胞癌的风险仍然存在。