解毒乙型肝炎再激活患者抗病毒治疗后早期乙型肝炎表面抗

StephenW

Dig Dis Sci. 2019 Apr 13. doi: 10.1007/s10620-019-05614-6. [Epub ahead of print]
Early Hepatitis B Surface Antigen Seroclearance Following Antiviral Treatment in Patients with Reactivation of Resolved Hepatitis B.
Lee HL1, Jang JW2, Han JW3, Lee SW1, Bae SH1, Choi JY1, Han NI1, Yoon SK1, Kim HJ4, Lee S4, Cho SG4, Min CK4, Kim DW4, Lee JW4.
Author information

1
    Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
2
    Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. [email protected].
3
    Laboratory of Translational Immunology and Vaccinology, Graduate School of Medical Science and Engineering, KAIST, Daejeon, Republic of Korea.
4
    Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Abstract
BACKGROUND AND AIMS:

Long-term results on hepatitis B virus (HBV) reactivation in patients with resolved infection during anti-cancer therapy are unknown. This study investigated long-term risk and therapeutic endpoints including hepatitis B surface antigen (HBsAg) seroclearance following antiviral therapy in patients developing reactivation of resolved HBV.
METHODS:

The study included 528 consecutive HBsAg-negative/hepatitis B core antibody-positive patients who underwent rituximab treatment or hematopoietic stem cell transplantation (HSCT) between 2006 and 2016. Long-term outcomes of patients with reactivation after antiviral therapy were examined in comparison with 37 HBsAg-positive chronic carriers under the same medical settings.
RESULTS:

The 7-year cumulative rate of HBV reactivation was 10.8% and 57.9% in patients receiving rituximab treatment and HSCT, respectively. After antiviral initiation, patients with reactivation of resolved HBV showed significantly higher 1-year cumulative rates of hepatitis B e antigen seroconversion (69.2% vs. 22.6%, P = 0.008) and HBsAg seroclearance (61.8% vs. 3.3%, P < 0.001) than chronic HBsAg carriers. Reactivation of resolved HBV was independently predictive of HBsAg seroclearance in a combined group of reactivated patients and chronic HBsAg carriers. Low viral load at reactivation was predictive of HBsAg seroclearance in reactivated patients. The majority of patients with HBsAg seroclearance developed anti-HBs. None of the reactivated patients who achieved HBsAg seroclearance relapsed after cessation of antiviral therapy.
CONCLUSIONS:

HBsAg seroclearance rapidly occurs following antiviral therapy for reactivation of resolved HBV infection, suggesting distinct clinical phenotypes as well as shorter duration of HBV infection associated with this particular disease setting-HBV reactivation.
KEYWORDS:

Antiviral therapy; HBV reactivation; HBsAg seroclearance; Resolved hepatitis B

PMID:
    30982209
DOI:
    10.1007/s10620-019-05614-6

StephenW

Dig Dis Sci。 2019年4月13日doi：10.1007 / s10620-019-05614-6。 [印刷前的电子版]
解毒乙型肝炎再激活患者抗病毒治疗后早期乙型肝炎表面抗原血清清除率
Lee HL1，Jang JW2，Han JW3，Lee SW1，Bae SH1，Choi JY1，Han NI1，Yoon SK1，Kim HJ4，Lee S4，Cho SG4，Min CK4，Kim DW4，Lee JW4。
作者信息

1
    韩国天主教大学医学院内科医学系，韩国首尔。
2
    韩国天主教大学医学院内科医学系，韩国首尔。 [email protected]。
3
    韩国大田KAIST医学科学与工程研究生院转化免疫学和疫苗学实验室。
4
    韩国天主教大学医学院内科，血液科，韩国首尔。

抽象
背景和目的：

在抗癌治疗期间解决感染的患者中乙型肝炎病毒（HBV）再激活的长期结果尚不清楚。该研究调查了长期风险和治疗终点，包括抗病毒治疗后乙型肝炎表面抗原（HBsAg）血清清除率，这些患者发生了已解决的HBV再激活。
方法：

该研究纳入了528例HBsAg阴性/乙型肝炎核心抗体阳性患者，他们在2006年至2016年间接受了利妥昔单抗治疗或造血干细胞移植（HSCT）。检查了抗病毒治疗后再激活患者的长期预后。 HBsAg阳性慢性携带者在相同的医疗环境下。
结果：

接受利妥昔单抗治疗和HSCT的患者的7年累积HBV再激活率分别为10.8％和57.9％。抗病毒药物开始后，已解决的HBV再激活患者显示出1年累积的乙型肝炎e抗原血清转换率（69.2％vs。22.6％，P = 0.008）和HBsAg血清清除率（61.8％vs。3.3％，P <0.001） ）比慢性HBsAg携带者。已解决的HBV的重新激活可独立预测重新激活的患者和慢性HBsAg携带者的联合组中的HBsAg血清清除率。重新激活时的低病毒载量可预测再激活患者的HBsAg血清清除率。大多数HBsAg血清清除患者发生抗-HBs。在停止抗病毒治疗后，达到HBsAg血清清除率的再激活患者均未复发。
结论：

HBsAg血清清除率在抗病毒治疗后迅速发生，用于重新激活已消退的HBV感染，提示不同的临床表型以及与此特定疾病 -  HBV再激活相关的HBV感染持续时间较短。
关键词：

抗病毒治疗; HBV再激活; HBsAg血清清除率;解决了乙型肝炎

结论：
    30982209
DOI：
    10.1007 / s10620-019-05614-6