对HBeAg阴性的慢性乙型肝炎进行严重肝炎发作的再治疗：结合

StephenW

J Viral Hepat. 2019 Dec 23. doi: 10.1111/jvh.13253. [Epub ahead of print]
Re-treatment for severe hepatitis flare in HBeAg-negative chronic hepatitis B: An appraisal with combined HBsAg/ALT kinetics.
Chien RN1, Liaw YF1.
Author information

1
    Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.

Abstract

To test the concept that off-therapy hepatitis flares with increasing qHBsAg require immediate re-treatment whereas re-treatment can be held or not necessary for those with decreasing qHBsAg, pre-retreatment combined HBsAg/ALT kinetics were classified in 22 patients with severe hepatitis flare (ALT > 30X ULN) and checked against their clinical response and qHBsAg changes during entecavir re-treatment. Timely re-treatment in 16 patients with increasing qHBsAg during hepatitis flare (Pattern I HBV/ALT kinetics) not only improved hepatitis and rescued impending/ensuring hepatic decompensation but also led to "rapid HBsAg decline" with 14 patients showing HBsAg decline > 1-4 log10 IU/mL within 12 months. In contrast, re-treatment in 6 patients with decreasing qHBsAg (Pattern II) resulted in small HBsAg decline in one patient and initial further HBsAg decline but rebound to pre-retreatment level in 3 patients. Of note, stopping 8-day re-treatment in a patient with pre-retreatment HBsAg decline > 1 log10 IU/mL allowed further HBsAg decline to a low level (4 IU/mL) toward HBsAg loss. These findings suggest that immediate re-treatment is appropriate in severe hepatitis flare with Pattern I HBsAg/ALT kinetics but can be held or even not necessary in those with Pattern II HBsAg/ALT kinetics. Serial qHBsAg assays, more frequently during hepatitis flare, are helpful for re-treatment decision and close monitoring is mandatory to start, to hold or to stop re-treatment in patients with hepatitis flare.

© 2019 John Wiley & Sons Ltd.
KEYWORDS:

Entecavir; HBsAg kinetics; Hepatitis B flare

PMID:
    31868280
DOI:
    10.1111/jvh.13253

StephenW

J病毒性肝炎。 2019年12月23日.doi：10.1111 / jvh.13253。 [Epub提前发布]
对HBeAg阴性的慢性乙型肝炎进行严重肝炎发作的再治疗：结合HBsAg / ALT动力学的评估。
Chien RN1，Liaw YF1。
作者信息

1个
    台湾台北市长庚大学医学院长庚纪念医院肝脏研究室。

抽象

为了验证qHBsAg升高的非治疗性肝炎发作需要立即重新治疗的观点，而对于qHBsAg降低的患者，可以进行重新治疗或不进行重新治疗，对22例重度肝炎患者进行了治疗前联合HBsAg / ALT动力学分类在恩替卡韦重新治疗期间出现耀斑（ALT> 30X ULN）并检查其临床反应和qHBsAg变化。及时对16例肝炎发作期间qHBsAg升高的患者进行重新治疗（模式I HBV / ALT动力学），不仅改善了肝炎并挽救了即将发生的/确保的肝代偿失调，而且导致“快速HBsAg下降”，其中14例患者的HBsAg下降> 1-在12个月内达到4 log10 IU / mL。相反，对6例qHBsAg降低的患者进行再治疗（模式II）导致1例患者的HBsAg小幅下降，最初HBsAg进一步下降，但3例患者反弹至治疗前水平。值得注意的是，在治疗前HBsAg下降> 1 log10 IU / mL的患者中停止8天再治疗可使HBsAg进一步下降至低水平（4 IU / mL），从而导致HBsAg下降。这些发现表明，对于具有I型HBsAg / ALT动力学的严重肝炎发作，立即进行再治疗是适当的，但对于具有II型HBsAg / ALT动力学的患者则可以保留甚至不需要。进行qHBsAg连续测定（在肝炎发作期间更为频繁）有助于做出重新治疗的决定，必须对开始，维持或停止肝炎发作的患者进行严密监测。

©2019 John Wiley＆Sons Ltd.
关键字：

恩替卡韦; HBsAg动力学；乙肝爆发

PMID：
    31868280
DOI：
    10.1111 / jvh.13253