AASLD2019[470]长期治疗结束时HBsAg水平 （EOT）与核苷类似物（NA

StephenW

470
HBsAg LEVELS AT THE END OF LONG-TERM THERAPY
(EOT) WITH NUCLEOS(T)IDE ANALOGUES (NA) AFFECT THE
OUTCOMES OF NON-CIRRHOTIC PATIENTS WITH HBEAGNEGATIVE
CHRONIC HEPATITIS B (CHBE-)
Margarita Papatheodoridi1, Emilia Hadziyannis2, Afroditi
Orfanidou1, Kalliopi Zachou3, Anastasia Kourikou2, Anastasia
Tzakou4, Spilios Manolakopoulos1,2, George N. Dalekos3,
Stephanos J. Hadziyannis4 and George V Papatheodoridis1,
(1)Department of Gastroenterology, Medical School of
National and Kapodistrian University of Athens, General
Hospital of Athens “Laiko”, Athens, Greece, (2)2nd
Department of Internal Medicine, Medical School of National
and Kapodistrian University of Athens, General Hospital
of Athens “Hippokratio”, Athens, Greece, (3)Department
of Internal Medicine & Research Laboratory, Thessalia
University Medical School, (4)Liver Clinic, Athens, Greece
Background: EOT HBsAg serum levels have been
associated with subsequent HBsAg loss in non-cirrhotic
patients with CHBe- who discontinue long-term NA However,
their prognostic value for post-NA relapse or remission
remains unclear Thus, we assessed the rates of relapse,
retreatment and HBsAg loss in relation to EOT HBsAg levels
in a large cohort of non-cirrhotic CHBe- patients from 4
liver clinics in Greece Methods: We included 136 patients
(mean age at discontinuation: 58±12 years, males: 107/136)
who discontinued NA therapy after mean on-NA virological
remission of 6 5± 3 1 years and had at least 12 months of
post-NA follow-up Patients with coinfection, cirrhosis, cancer
or liver transplantation were excluded Patient characteristics
before therapy as well as ΑLT, HBV DNA and HBsAg levels
at EOT and post-NA were recorded Patients were divided
in 3 groups based on EOT HBsAg levels: Α:≤100 IU/mL,
B:>100-1000 IU/mL, C:>1000 IU/mL. Study endpoints were
virological relapse (HBV DNA>2000 IU/mL), clinical relapse
(HBV DNA>2,000 IU/mL & ALT>2ULN), retreatment and
HBsAg loss Results: Μean post-NA follow-up was 43±36
months The cumulative rates of virological relapse did not
differ significantly among patients of group A, B, C being 46%,
43%, 41% at 6 months and 50%, 64%, 74% at 12 months,
respectively (log-rank, P=0 39) In contrast, the cumulative
rates of clinical relapse were significantly different among
groups A, B, C being 16%, 34%, 31% at 6 months and 16%,
34%, 38% at 12 months, respectively (log-rank, P=0 05) The
cumulative rates of retreatment differed significantly between
group Α, Β, C being 8%, 24%, 28% at 6 months and 8%,
24%, 31% at 12 months, respectively (log-rank, P=0 01)
Only 2 cases of retreatment and one of virological relapse
were observed after 12 months Finally, the cumulative rates
of HBsAg loss also differed significantly among groups A, B,
C being 38%, 9%, 7% at 12 months and 64%, 15%, 12% at
36 months, respectively (log-rank, P<0 001) Conclusion: In
non-cirrhotic CHBe- patients who discontinue long-term NA
therapy, the outcomes differ significantly according to their
HBsAg levels at EOT. Patients with EOT HBsAg ≤100 IU/mL
have significantly lower risk of clinical relapse or retreatment
and higher probability of HBsAg loss; thus, such patients can
safely stop NA therapy and often achieve post-NA functional
cure (HBsAg loss).Yet, patients with EOT HBsAg >100 IU/
mL infrequently clear HBsAg within the first 3 years but the
majority of them remain without clinical relapse or need for
retreatment.

StephenW

470
长期治疗结束时HBsAg水平
（EOT）与核苷类似物（NA）影响
非肝硬化患者的结果
慢性乙型肝炎（CHBE-）
玛格丽塔（Mr.Margarita Papatheodoridi）
Orfanidou1，Kalliopi Zachou3，Anastasia Kourikou2，Anastasia
Tzakou4，Spilios Manolakopoulos1,2，George N.Dalekos3，
Stephanos J.Hadziyannis4和George V Papatheodoridis1，
（1）中国医学科学院消化内科
雅典国立和卡波季第安大学
希腊雅典雅典“ Laiko”医院，（2）2nd
国立医学院内科
和雅典卡波迪斯安大学综合医院
希腊雅典，雅典“ Hippokratio”（3）
塞萨利亚内部医学与研究实验室
大学医学院，（4）肝脏诊所，希腊雅典
背景：EOT HBsAg血清水平一直
与非肝硬化患者随后的HBsAg丢失相关
长期停用NA的CHBe-患者
对NA后复发或缓解的预后价值
尚不清楚因此，我们评估了复发率，
再治疗和HBsAg丢失与EOT HBsAg水平的关系
一大批非肝硬化性CHBe患者中，有4名
希腊的肝脏诊所方法：我们纳入了136例患者
（停药时的平均年龄：58±12岁，男性：107/136）
在平均NA病毒学水平后终止NA治疗的人
缓解6 5±3 1年，并且至少有12个月的缓解
NA后随访合并感染，肝硬化，癌症患者
或肝移植被排除
治疗前以及ALT，HBV DNA和HBsAg水平
在EOT和NA后记录患者
根据EOT HBsAg水平分为3组：Α：≤100IU / mL，
B：> 100-1000 IU / mL，C：> 1000 IU / mL。研究终点为
病毒学复发（HBV DNA> 2000 IU / mL），临床复发
（HBV DNA> 2,000 IU / mL和ALT> 2ULN），再次治疗和
HBsAg丢失结果：NA后的随访时间为43±36
个月病毒学复发的累积率没有
A，B，C组的患者之间差异显着，为46％，
在6个月时为43％，41％，在12个月时为50％，64％，74％，
分别（对数秩，P = 0 39）相反，累积
临床复发率之间存在显着差异
A，B，C组分别为16％，34％，6个月时31％和16％，
在12个月时分别为34％，38％（对数秩，P = 0 05）
累积的再治疗率之间存在显着差异
组Α，Β，C为8％，24％，6个月时为28％和8％，
12个月时分别为24％，31％（对数等级，P = 0 01）
仅2例再治疗和1例病毒学复发
在12个月后被观察到
A，B组之间的HBsAg丢失比例也存在显着差异，
C在12个月时为38％，9％，7％，在12个月时为64％，15％，12％
分别为36个月（log-rank，P <0 001）结论：
非肝硬化性CHBe-停用长期NA的患者
疗法，结果根据他们的
EOT时的HBsAg水平。 EOT HBsAg≤100 IU / mL的患者
临床复发或复发的风险大大降低
HBsAg丢失的可能性更高；因此，这类患者可以
安全地停止NA治疗并经常实现NA后功能
治愈（HBsAg丢失）。但是，EOT HBsAg> 100 IU /
最初3年内，mL很少清除HBsAg，但是
他们中的大多数仍然没有临床复发或需要
再治疗。