早期开始抗病毒治疗有助于婴儿乙型肝炎患者血清HBsAg的快速

StephenW

J Hepatol. 2019 Jun 19. pii: S0168-8278(19)30356-3. doi: 10.1016/j.jhep.2019.06.009. [Epub ahead of print]
Early initiation of antiviral therapy contributes to a rapid and significant loss of serum HBsAg in infantile-onset hepatitis B.
Zhu S1, Dong Y1, Wang L1, Liu W2, Zhao P3.
Author information

1
    The Fifth Medical Center (formerly Beijing 302 Hospital), Chinese PLA General Hospital, Beijing 100039, China.
2
    Medical Statistics Section, Academy of Military Medical Sciences, Beijing 100850, China.
3
    The Fifth Medical Center (formerly Beijing 302 Hospital), Chinese PLA General Hospital, Beijing 100039, China; The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan 453100, China. Electronic address: [email protected].

Abstract
BACKGROUND & AIM:

There is a paucity of data regarding antiviral therapy in hepatitis B virus (HBV)-infected infants aged <1 year with elevated ALT. This study aims to assess the efficacy and safety of antiviral therapy initiated in infancy.
METHODS:

A real-world cohort study was conducted from January 2010 to December 2017. HBV-infected infants with persistent elevation of ALT and high viral load under 1 year of age were recruited and divided into 2 groups. Group I included 18 infants whose parents chose to initiate antiviral therapy with lamivudine before 1 year of age. Group II included 11 infants whose parents chose to initiate antiviral therapy with interferon-α after 1 year of age and not to receive any antiviral therapies before 1 year of age.The main outcome measure was rate of serum HBsAg loss at month 12 of treatment.
RESULTS:

There were no statistical differences between Groups I and II regarding baseline characteristics. No infants in Group II developed spontaneous HBsAg loss before 1 year of age. In Group I, the cumulative rates of HBsAg loss at month 3, 6, 9 and 12 of treatment were respectively 39%, 67%, 78% and 83%. In Group II, the cumulative rates of HBsAg loss at month 3, 6, 9 and 12 of treatment were respectively 18%, 27%, 27% and 36%. Statistical differences existed in the cumulative rates of HBsAg loss between the two groups (log-rank test, P=0.0023). No serious adverse events occurred in the study.
CONCLUSION:

Early initiation of antiviral therapy contributes to a rapid and significant loss of HBsAg for infantile-onset hepatitis B. Further trials with larger cohorts are needed to verify our results.
LAY SUMMARY:

Chronicity is a serious threat to infantile hepatitis B. However, no treatment measure has been recommended for infants with onset hepatitis B in current guidelines. In order to evaluate the benefit and safety of antiviral therapy in infantile-onset hepatitis B, a real-world cohort study was conducted. Long-term follow-up results showed that early initiation of antiviral therapy with lamivudine safely led to a rapid and significant loss of serum HBsAg in the present subset of infants with ALT >=2 times upper limit of normal. Further trials with larger cohorts are needed.

Copyright © 2019. Published by Elsevier B.V.
KEYWORDS:

Antiviral therapy; Hepatitis B virus; Infant

PMID:
    31228491
DOI:
    10.1016/j.jhep.2019.06.009

StephenW

J Hepatol。 2019年6月19日.pii：S0168-8278（19）30356-3。 doi：10.1016 / j.jhep.2019.06.009。 [印刷前的电子版]
早期开始抗病毒治疗有助于婴儿乙型肝炎患者血清HBsAg的快速和显着丧失。
朱S1，董Y1，王L1，刘W2，赵P3。
作者信息

1
中国人民解放军总医院第五医疗中心（原北京302医院），北京100039
2
军事医学科学院医学统计科，北京100850
3
中国人民解放军总医院第五医疗中心（原北京302医院），北京100039;新乡医科大学附属第一医院，河南卫辉453100电子地址：[email protected]。

抽象
背景与目的：

关于乙型肝炎病毒（HBV）感染婴儿<1岁且ALT升高的抗病毒治疗的数据很少。本研究旨在评估婴儿期开始的抗病毒治疗的有效性和安全性。
方法：

从2010年1月至2017年12月进行了一项真实世界的队列研究。招募了HBV感染的婴儿，其持续升高的ALT和1岁以下的高病毒载量，并分为2组。第一组包括18名婴儿，其父母选择在1岁之前用拉米夫定主动抗病毒治疗。第二组包括11名婴儿，其父母选择在1岁后开始使用干扰素-α进行抗病毒治疗，并且在1岁之前不接受任何抗病毒治疗。主要结果指标是治疗第12个月时血清HBsAg消失率。
结果：

在第一组和第二组之间没有关于基线特征的统计差异。 II组婴儿在1岁之前没有发生自发性HBsAg损失。在第一组中，治疗第3,6,9和12个月HBsAg消失的累积率分别为39％，67％，78％和83％。在第II组中，治疗第3,6,9和12个月的HBsAg消失累积率分别为18％，27％，27％和36％。两组间HBsAg消失累积率的差异（log-rank检验，P = 0.0023）。研究中未发生严重不良事件。
结论：

早期开始抗病毒治疗有助于婴儿型乙型肝炎患者HBsAg的快速和显着丧失。需要进一步的大型队列试验来验证我们的结果。
LAY总结：

慢性病对婴儿乙型肝炎是一种严重的威胁。但是，目前的指南中没有建议对乙型肝炎发病的婴儿采取治疗措施。为了评估抗病毒治疗在婴儿期乙型肝炎中的益处和安全性，进行了一项真实世界的队列研究。长期随访结果显示，拉米夫定早期开始抗病毒治疗可安全地导致ALT> =正常上限2倍的婴儿亚组血清HBsAg迅速显着下降。需要具有更大群组的试验。

版权所有©2019。Elsevier B.V.
关键词：

抗病毒治疗;乙型肝炎病毒;婴儿

结论：
31228491
DOI：
10.1016 / j.jhep.2019.06.009

齐欢畅

婴儿时期抗病毒，体内的特异性免疫细胞还未彻底枯竭，所以可以激活免疫
待到成年，人体的特异性细胞已经完全枯竭，这个时候只有过继免疫的方法，重新获得特异性免疫细胞，才可以彻底激活免疫。
我坚信这是个对的路子。

dxd2017

回复 齐欢畅 的帖子

其实病人很多想法比医生强，只是医生自己不是病人，没有同理心不想折腾研究。你的这个过继免疫如果要验证可能比研制药物更快有结果。

齐欢畅

dxd2017 发表于 2019-6-24 20:33
回复 齐欢畅 的帖子

其实病人很多想法比医生强，只是医生自己不是病人，没有同理心不想折腾研究。你的这个 ...

普通生物学上有这个记载，我高中参加生物竞赛，学过。