AASLD2019[494]NUC治疗期间的HBEAG丢失率低于 CHB乙型肝炎病毒阳性

StephenW

494
HBEAG LOSS RATE DURING NUC THERAPY WAS LOWER THAN
NATURAL HISTORY IN CHB HBEAG POSITIVE PATIENTS WITH
HEPATITIS FLARE
Chien-Wei Peng1,2, Wen-Juei Jeng2,3 and Yun-Fan Liaw2,4,
(1)Department of Gastroenterology and Hepatology,
Chang Gung Memorial Hospital, Linkou Branch, (2)College
of Medicine, Chang Gung University, (3)Department of
Gastroenterology and Hepatology, Chang Gung Memorial
Hospital, Linkou Branch, Taiwan, (4)Liver Research Unit,
Chang Gung Memorial Hospital, Linkou Branch
Background: Spontaneous HBeAg loss rate was reported
to be 31% within three months and 62% within one year
after hepatitis flare (AE: ALT ³ 5X ULN) with AFP ³ 100ng/
ml in natural history The elevation of AFP has been known
related to histologic bridging hepatic necrosis. Such flare
with AFP ³ 100ng/ml has also associated with rapid HBsAg
decline during Nuc therapy. However, the influence of AFP
level on the HBeAg loss rate as compared with that in
untreated setting is unknown Thus, we aimed to clarify
the impact of AFP on HBeAg loss rate during Nuc therapy
Methods: HBeAg positive chronic hepatitis B patients who
received Nuc therapy with proper measurement of AFP level
in the beginning of treatment were recruited Baseline age,
gender, cirrhosis, ALT, genotype, HBsAg and HBV DNA
levels were analyzed. Serum HBV DNA was measured by
Cobas Amplicor HBV Monitor (Roche Diagnostics, negative
<20IU/ml), HBsAg was measured using Roche Elecsys II
kit (negative <0,05 IU/ml) Results: A total of 293 HBeAg
positive patients with 320 treatment course were analyzed
The median age was 44 3 (17 8~77 6) year-old, 72 2% were
males, 55 9% were genotype B, 44 1% were genotype C and
24 7% were cirrhotics Of these patients, 208 (65%) showed
HBeAg loss at a median time of 11 6 (0 4-104 4) months of
therapy during median follow-up duration of 56.6 months: 41
(12 8%), 107 (33 4%) within 3 months and 1 year respectively
One-year HBeAg loss rate in patients with baseline ALT level
< 5X, 5-10X, 10-20X, > 20X ULN was 17.2%, 24.2%, 37.9%,
and 51 5%, respectively (P<0 0001); AFP level < 20, 20-100,
³100 was 26.8%, 38.0%, 48.6%, respectively (P=0.0005).
Among patients with AE, HBeAg loss rate in AFP < 20, 20-
99, ³100 was 34.3%, 40.4%, 48.6%, respectively (P=0.0894).
The patients with AE and AFP > 100ng/ml HBeAg loss rate
within 3 months and one year were 26% and 49%, lower than
the spontaneous HBeAg loss rate reported (31% and 62%)
Among the 142 patients off-Nuc therapy, 38 patients showed
HBeAg reversion (26 7%) Conclusion: The 1-year HBeAg
loss rate during Nuc therapy has dose dependent relationship
with on-treatment ALT level and AFP level However, HBeAg
seroconversion rate by 3-month and one year on-treatment
was lower than that reported in the untreated setting It is
possible that Nuc therapy may decrease HBsAg antigen
and halt the endogenous host immune driving toward
HBeAg loss or halt the virus evolution by direct replication
suppression.

StephenW

494
NUC治疗期间的HBEAG丢失率低于
CHB乙型肝炎病毒阳性患者的自然历史
肝炎耀斑
彭建伟1,2，姜文瑞2,3和李云凡2,4，
（1）消化内科
长庚纪念医院林口分院（2）
长庚大学医学院，（3）
肠胃病和肝病，长庚纪念馆
台湾林口分院医院，（4）肝脏研究室，
长庚纪念医院林口分院
背景：报告自发性HBeAg丢失率
在三个月内为31％，在一年内为62％
肝炎爆发后（AE：ALT³5X ULN）和AFP³100ng /
自然历史中的毫升数
与组织学桥接肝坏死有关。这样的耀斑
AFP³100ng / ml时也与快速HBsAg有关
在Nuc治疗期间下降。但是，法新社的影响
HBeAg丢失率水平与
未经处理的环境是未知的因此，我们旨在澄清
酸治疗期间AFP对HBeAg丢失率的影响
方法：HBeAg阳性的慢性乙肝患者
接受Nuc治疗并正确测量AFP水平
在治疗开始时就招募了基线年龄，
性别，肝硬化，ALT，基因型，HBsAg和HBV DNA
水平进行了分析。血清HBV DNA测定
Cobas Amplicor HBV监测仪（罗氏诊断，阴性
<20IU / ml），使用Roche Elecsys II测量HBsAg
试剂盒（<0.05 IU / ml阴性）结果：总共293 HBeAg
对320疗程阳性患者进行了分析
中位年龄是44 3（17 8〜77 6）岁，72 2％是
男性，基因型B为55 9％，基因型C为44 1％，
这些患者中有24 7％为肝硬化患者，其中208名（65％）
HBeAg丢失的中位时间为11 6（0 4-104 4）个月
在56.6个月的中位随访期间进行的治疗：41
（3个月）和（1年）分别为（12 8％），107（33 4％）
基线ALT水平患者的一年HBeAg丢失率
<5倍，5-10倍，10-20倍，> 20倍ULN为17.2％，24.2％，37.9％，
和51 5％（P <0 0001）; AFP等级<20、20-100，
³100分别为26.8％，38.0％，48.6％（P = 0.0005）。
在AE患者中，AFP中的HBeAg丢失率<20，20-
99，³100分别为34.3％，40.4％，48.6％（P = 0.0894）。
AE和AFP> 100ng / ml HBeAg丢失率的患者
在3个月和一年之内分别为26％和49％，低于
报告的自发性HBeAg丢失率（31％和62％）
在142例非Nuc治疗患者中，有38例显示
HBeAg逆转（26 7％）结论：1年期HBeAg
Nuc治疗过程中的流失率具有剂量依赖性
治疗中的ALT水平和AFP水平升高，但是HBeAg
治疗3个月和一年的血清转化率
低于未治疗环境中报告的
Nuc治疗可能会降低HBsAg抗原
并阻止内源性宿主向
HBeAg丢失或通过直接复制阻止病毒进化
抑制。