在HBeAg阴性慢性乙型肝炎患者中停止核苷酸（t）类似物治疗

StephenW

Liver Int. 2019 Dec 16. doi: 10.1111/liv.14330. [Epub ahead of print]
The safety of stopping nucleos(t)ide analogue treatment in patients with HBeAg-negative chronic hepatitis B.
Wong GL1,2,3, Chan HL1,2,3, Yuen BW1, Tse YK1,2, Luk HW2, Yip TC1,2, Hui VW4, Liang LY1,2, Lee HW5, Lui GC2, Wong VW1,2,3.
Author information

1
    Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
2
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
3
    State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
4
    Department of Statistics, The Chinese University of Hong Kong, Hong Kong SAR, China.
5
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.

Abstract
BACKGROUND:

The rates of hepatitis B surface antigen (HBsAg) seroclearance after stopping nucleos(t)ide analogues (NA) in European (19% in 2 years) and Asian (13% in 6 years) patients with chronic hepatitis B (CHB) vary dramatically. We evaluated the incidence of hepatitis flare and HBsAg seroclearance in hepatitis B e antigen (HBeAg)-negative Chinese CHB patients who had stopped NA.
METHODS:

This was a territory-wide retrospective study in Hong Kong. We identified HBeAg-negative CHB patients 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%) when starting NA; they stopped NA after 82±35 months of treatment. At 44.3 ± 24.6 months after stopping NA, 147 (13.6%) patients had hepatitis flare, which led to resumption of NA; whereas 77 (7.2%) patients had flare but did not resume NA. Decompensation occurred in 7/914 (0.8%) patients. 695 (64.6%) patients remained on NA treatment at the last visit. Eleven patients had achieved HBsAg seroclearance (six of them had hepatitis flare and one of these six patients achieved HBsAg seroclearance after NA was restarted). Hepatic events developed in 75/695 (10.8%) patients who had NA resumed versus 43/381 (11.3%) patients who did not resume NA (p=0.677) CONCLUSIONS: Hepatitis flare and retreatment were common in HBeAg-negative CHB patients who stopped NA treatment; whereas HBsAg seroclearance rarely occurred. Stopping NA to achieve functional cure should not be recommended at this moment.

© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PMID:
    31845462
DOI:
    10.1111/liv.14330

StephenW

肝内科。 2019年12月16日.doi：10.1111 / liv.14330。 [Epub提前发布]
在HBeAg阴性慢性乙型肝炎患者中停止核苷酸（t）类似物治疗的安全性。
Wong GL1,2,3，Chan HL1,2,3，Yen BW1，Tse YK1,2，Luk HW2，Yip TC1,2，Hui VW4，Liang LY1,2，Lee HW5，Lui GC2，Wong VW1,2,3 。
作者信息

1个
中国香港特别行政区香港中文大学消化系统疾病研究所。
2
香港中文大学，香港特别行政区医学与治疗学系。
3
香港中文大学，消化病国家重点实验室，香港特别行政区。
4
中国香港特别行政区香港中文大学统计系。
5
延世大学医学院内科，韩国首尔。

抽象
背景：

欧洲（2年为19％）和亚洲（6年为13％）慢性乙型肝炎（CHB）患者停用核苷类似物（NA）后的乙型肝炎表面抗原（HBsAg）血清清除率差异很大我们评估了已停止NA的乙型肝炎e抗原（HBeAg）阴性的中国CHB患者的肝炎爆发和HBsAg血清清除率。
方法：

这是香港的一项全港性回顾性研究。我们确定了2000年1月至2017年12月HBeAg阴性的CHB患者，他们已停止NA治疗超过3个月。肝炎发作定义为ALT> 2xULN。
结果：

1 076例患者开始NA时主要为中年男性（平均年龄52岁，男性74.8％）；他们在82±35个月的治疗后停止了NA。停止NA后44.3±24.6个月，有147例（13.6％）患者出现肝炎发作，导致NA恢复。而77名（7.2％）患者出现了耀斑，但没有恢复NA。代偿失调发生在7/914（0.8％）患者中。在最后一次访视时，有695（64.6％）例患者继续接受NA治疗。 11例患者已达到HBsAg血清清除（其中6例患有肝炎发作，而6例患者中的1例在重新启动NA后达到HBsAg血清清除）。肝功能恢复的75/695（10.8％）患者发生肝事件，而未恢复NA的43/381（11.3％）患者发生肝事件（p = 0.677）结论：HBeAg阴性的CHB患者常见肝炎发作和再治疗停止NA治疗；而很少发生HBsAg血清清除。目前不建议停止NA以达到功能性治愈。

©2019 John Wiley＆Sons A / S。由John Wiley＆Sons Ltd发布。

PMID：
31845462
DOI：
10.1111 / liv.14330