AASLD2019[479]在处理反应方面的显着差异 HBsAg / ALT动力学不同的

StephenW

479
REMARKABLE DIFFERENCE IN RE-TREATMENT RESPONSE IN
PATIENTS WITH DIFFERENT HBsAg/ALT KINETICS DURING
OFF-NUC HEPATITIS FLARE
Wen-Juei Jeng1,2, Yen-Chun Liu1,2, Rong-Nan Chien1,2 and
Yun-Fan Liaw3,4, (1)College of Medicine, Chang Gung
University, Taiwan, (2)Department of Gastroenterology and
Hepatology, Chang Gung Memorial Hospital, Linkou Branch,
Taiwan, (3)Liver Research Unit, Chang Gung Memorial
Hospital, Linkou Branch, (4)College of Medicine, Chang Gung
University
Background: Off-Nuc hepatitis flare (AE: ALT > 5X ULN) with
deceasing qHBsAg may reflect successful immune clearance
whereas those with increasing qHBsAg reflect ineffective
immune response Aim: To investigate whether AE with
different pretherapy HBsAg/ALT kinetics showed different retreatment
response Methods: HBeAg-negative off-Nuc AE
with qHBsAg at ≥3 time points (pre-flare, during flare, months
6 and/or 12 of re-treatment) were studied Pre-treatment
ALT, HBV DNA and qHBsAg levels, on-treatment start to
ALT normalization, undetectable HBV DNA, the presence of
“rapid HBsAg decline” (HBsAg decline > 0.5log10 in 6 months
or > 1 log10IU/ml in 12 months) during re-treatment were
compared between patients with different pretherapy HBsAg/
ALT kinetics Logistic regression was applied Results: Of
202 patients with off-Nuc flare, 18.8% showed decreasing
qHBsAg (group I) and 81 2% showed increasing qHBsAg
(group II) The two groups were comparable in demographic
features, previous treatment and consolidation duration, but
higher end of treatment (EOT) qHBsAg in group I (median:
2 9 vs 2 7 Log10IU/ml, P=0 001) At the start of re-treatment,
group I patients had lower ALT level (median: 251 vs. 388
U/L, P=0.0001), lower HBV DNA level (5.8 vs. 6.7 log10IU/
ml, P=0 0002) and lower qHBsAg level (2 7 vs 3 4 log10IU/
ml, P<0 0001) During re-treatment, “rapid HBsAg decline”
occurred in 73 2% of group II vs 7 9% of group I patients
(P<0 0001), median qHBsAg decline by month 12 was -0 07
log10IU/ml vs -0 91 log10IU/ml (Figure) Higher ALT level
(³ 10X ULN vs 5-10X ULN, aOR: 2.8 (1.3-6.2), P=0.008),
higher HBV DNA level [>7 log10IU/ml: aOR: 3.5 (1.2-10.2),
P=0.219], higher qHBsAg level [aOR: 4.1 (1.8-9.5), P=0.003]
at start of re-treatment and group II patients [vs. group I:
aOR: 19.6 (4.8-80.7), P<0.001] were independent factors for
“rapid HBsAg decline” Remarkably, 78 9%, 13 2% of group
I vs 26 2%, 0% of group II patients showed stationary and
increased qHBsAg level respectively at month 12 (P<0 0001)
Conclusion: Patients with decreasing qHBsAg during off-
Nuc AE showed minimal decline or even increasing qHBsAg
during re-treatment Perhaps re-treatment in such patients
is too soon that halt endogenous immune control Further
observation is necessary to decide the necessity or timing of
re-treatment.

StephenW

479
在处理反应方面的显着差异
HBsAg / ALT动力学不同的患者
非核肝炎耀斑
曾文瑞1,2，刘延春1,2，钱荣南1,2和
廖云帆3,4，（1）长庚医学院
台湾大学（2）消化内科
长口纪念医院林口分院肝病科
台湾（3）长庚纪念馆肝脏研究组
长庚医学院附属医院林口分院（4）
大学
背景：核仁外肝炎发作（AE：ALT> 5X ULN）
qHBsAg降低可能反映成功的免疫清除
而那些qHBsAg升高的患者则无效
免疫反应目的：探讨AE是否与
不同的治疗前HBsAg / ALT动力学表现出不同的再治疗
应对方法：HBeAg阴性off-Nuc AE
qHBsAg≥3个时间点（爆发前，爆发期间，
研究了6和/或12的再处理）
ALT，HBV DNA和qHBsAg水平开始治疗
ALT正常化，无法检测到的HBV DNA，
“快速HBsAg下降”（6个月内HBsAg下降> 0.5log10
或在再治疗期间12个月内> 1 log10IU / ml）
不同治疗前HBsAg /患者之间的比较
应用ALT动力学Logistic回归结果：
202例Nuc耀斑患者，下降18.8％
qHBsAg（I组）和81 2％的患者显示qHBsAg增加
（第二组）两组在人口统计学上可比
功能，以前的治疗和巩固时间，但是
第一组的治疗终点（EOT）qHBsAg（中位数：
2 9 vs 2 7 Log10IU / ml，P = 0 001）在重新治疗开始时，
第一组患者的ALT水平较低（中位数：251 vs. 388
U / L，P = 0.0001），降低HBV DNA水平（5.8与6.7 log10IU /
ml，P = 0 0002）和较低的qHBsAg水平（2 7 vs 3 4 log10IU /
ml，P <0 0001）在重新治疗期间，“ HBsAg快速下降”
发生在第二组的73 2％相对于第一组的7 9％
（P <0 0001），第12个月的qHBsAg中位数下降为-0 07
log10IU / ml vs -0 91 log10IU / ml（图）更高的ALT水平
（³10倍ULN和5-10倍ULN，aOR：2.8（1.3-6.2），P = 0.008），
更高的HBV DNA水平[> 7 log10IU / ml：aOR：3.5（1.2-10.2），
P = 0.219]，更高的qHBsAg水平[aOR：4.1（1.8-9.5），P = 0.003]
在开始重新治疗和II组患者时[vs.第一组：
aOR：19.6（4.8-80.7），P <0.001]是
“快速HBsAg下降”显着，占组的78 9％，13 2％
I vs 26 2％，II组患者中0％表现出平稳
第12个月qHBsAg水平分别升高（P <0 0001）
结论：在关闭期间qHBsAg降低的患者
Nuc AE表现出最小的qHBsAg下降甚至增加
在再治疗期间可能在这类患者中再治疗
停止内源性免疫控制还为时过早
观察是决定是否必要或定时的必要
再治疗。