AASLD2019[474]普通肝炎但罕见的HBsAg 停止NA治疗后的清仓 HBEAG阴

StephenW

474
COMMON HEPATITIS FLARE BUT RARE HBsAg
SEROCLEARANCE AFTER STOPPING NA TREATMENT IN
PATIENTS WITH HBEAG-NEGATIVE CHB PATIENTS
Grace L Wong1, Becky W.Y. Yuen2, Vicki Wing Ki Hui2, Yee-Kit
Tse1, Terry Cheuk-Fung Yip3, Lilian Yan Liang4, Henry Lik Yuen
Chan5 and Vincent Wai-Sun Wong6, (1)Institute of Digestive
Disease, Department of Medicine and Therapeutics, The
Chinese University of Hong Kong, (2)Department of Statistics,
The Chinese University of Hong Kong, (3)Department of
Medicine and Therapeutics, The Chinese University of Hong
Kong, (4)Department of Medicine and Therapeutics, Institute
of Digestive Disease, The Chinese University of Hong Kong,
(5)Institute of Digestive Disease, Department of Medicine
and Therapeutics, and State Key Laboratory of Digestive
Disease, The Chinese University of Hong Kong, Hong Kong,
(6)Department of Medicine and Therapeutics, The Chinese
University of Hong Kong, Hong Kong
Background: The rates of hepatitis B surface antigen (HBsAg)
seroclearance after stopping nucleos(t)ide analogues (NA)
treatment in European and Asian chronic hepatitis B (CHB)
patients are very different (19% in 2 years and 13% in 6
years respectively). We evaluated the incidences of hepatitis
flare and HBsAg seroclearance in a cohort of 1,076 HBeAgnegative
Chinese CHB patients Methods: This was a
territory-wide retrospective observational cohort study in
Hong Kong. We identified HBeAg-negative CHB patients
through the Clinical Data Analysis and Reporting System
(CDARS) based on the drug record of NA from January
2000 to December 2017 who had stopped NA treatment
for more than 3 months. Hepatitis flare was defined as ALT
>2xULN. Results: The 1,076 patients were predominantly
middle-aged men (mean age 52 years, male 74 8%; 8 3%
had compensated cirrhosis) at the time of starting NA; they
stopped NA after 82±35 months of treatment (80% entecavir,
16% tenofovir, 3% lamivudine) After stopping NA, 20 8% noncirrhotic
and 21.3% cirrhotic patients had hepatitis flare (with
7.6% and 11.2% ALT>5xULN); 31% and 16% had peak serum
HBV DNA >2000IU/mL; 13% and 32% INR>1.7; 47% and
95% total bilirubin>38μmol/L respectively. 71% non-cirrhotic
and 65% cirrhotic patients resumed NA treatment Only 10
(with 5 during NA retreatment) non-cirrhotic and one cirrhotic
patients had achieved HBsAg seroclearance Hepatic events
developed in 9 4% non-cirrhotic and 28 1% cirrhotic patients
at 9 5 ± 102 months after stopping NA Conclusion: Hepatitis
flare and retreatment were common in HBeAg-negative
CHB patients who stopped NA treatment; whereas HBsAg
seroclearance rarely occurred. Figure 1. Serial serum HBV
DNA results after stopping NA.

StephenW

474
普通肝炎但罕见的HBsAg
停止NA治疗后的清仓
HBEAG阴性CHB患者
Grace L Wong1，贝基W.Y.元2，永基慧2，怡杰
Tse1，Terry Cheuk-Fung Yip3，Lilian Yan Liang4，Henry Lik Yuen
Chan5和Vincent Wai-Sun Wong6，（1）消化研究所
疾病，医学与治疗学系
香港中文大学，（2）统计系，
香港中文大学，（3）
香港中文大学医学与治疗学
Kong（4）研究所医学与治疗学
香港中文大学消化系统疾病研究所
（5）医学部消化疾病研究所
和治疗学，消化系统国家重点实验室
疾病，香港中文大学，香港，
（6）中国医学治疗学系
香港大学，香港
背景：乙型肝炎表面抗原（HBsAg）的发生率
停止核苷酸（t）类似物（NA）后的血清清除
欧洲和亚洲慢性乙型肝炎（CHB）的治疗
患者差异很大（2年为19％，6年为13％
年）。我们评估了肝炎的发病率
1,076 HBe队列中的患者发作和HBsAg血清清除
中国CHB患者方法：这是一个
全港性回顾性观察队列研究
香港。我们确定了HBeAg阴性的CHB患者
通过临床数据分析和报告系统
（CDARS）基于一月份的不适用药物记录
2000年至2017年12月停止NA治疗
超过3个月。肝炎发作被定义为ALT
> 2xULN。结果：1,076名患者主要是
中年男性（平均年龄52岁，男性74 8％； 8 3％
在开始NA时已补偿肝硬化）；他们
在治疗82±35个月后停止NA（80％恩替卡韦，
16％替诺福韦，3％拉米夫定）停用NA后20％8％非肝硬化
和21.3％的肝硬化患者出现肝炎发作（
ALT> 5xULN分别为7.6％和11.2％）； 31％和16％的血清峰值
HBV DNA> 2000IU / mL; 13％和32％INR> 1.7； 47％和
总胆红素的95％>38μmol/ L。 71％非肝硬化
和65％肝硬化患者恢复NA治疗仅10
（NA复治期间5例）非肝硬化和1例肝硬化
患者已达到HBsAg血清清除肝事件
9例非肝硬化患者和28例1％肝硬化患者发生
停药后9 5±102个月时不适用结论：肝炎
HBeAg阴性的患者通常会出现耀斑和再治疗
停止NA治疗的CHB患者；而乙肝表面抗原
血清清除很少发生。图1.连续血清HBV
停止NA后DNA结果。