抗病毒药诱导的HBsAg血清清除后，终止核苷酸类似物与HBsAg血

StephenW

Gut. 2020 Mar 24. pii: gutjnl-2019-320015. doi: 10.1136/gutjnl-2019-320015. [Epub ahead of print]
Discontinuation of nucleos(t)ide analogues is not associated with a higher risk of HBsAg seroreversion after antiviral-induced HBsAg seroclearance: a nationwide multicentre study.
Kim MA1, Kim SU2, Sinn DH3, Jang JW4, Lim YS5, Ahn SH2, Shim JJ6, Seo YS7, Baek YH8, Kim SG9, Kim YS9, Kim JH10, Choe WH11, Yim HJ12, Lee HW13, Kwon JH14, Lee SW15, Jang JY16, Kim HY17, Park Y3, Kim GA6, Yang H4, Lee HA7, Koh M8, Lee YS10, Kim M12, Chang Y16, Kim YJ1, Yoon JH1, Zoulim F18, Lee JH19.
Author information

1
    Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
2
    Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
3
    Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
4
    Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
5
    Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
6
    Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, South Korea.
7
    Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
8
    Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea.
9
    Department of Internal Medicine, Bucheon Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea.
10
    Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
11
    Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, South Korea.
12
    Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea.
13
    Department of Internal Medicine and Yonsei Liver Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
14
    Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Incheon, South Korea.
15
    Department of Internal Medicine, Bucheon St. Mary's hospital, College of Medicine, Catholic University of Korea, Bucheon, South Korea.
16
    Department of Internal Medicine, Seoul Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea.
17
    Department of Inernal Medicine, Ewha Women's University College of Medicine, Seoul, South Korea.
18
    Cancer Research Centre of Lyon, INSERM U1052, Lyon University, Hospices Civils de Lyon, Lyon, France.
19
    Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea [email protected].

Abstract
OBJECTIVE:

Direct comparison of the clinical outcomes between nucleos(t)ide analogue (NA) discontinuation versus NA continuation has not been performed in patients with chronic hepatitis B who achieved HBsAg-seroclearance. Whether NA discontinuation was as safe as NA continuation after NA-induced surface antigen of HBV (HBsAg) seroclearance was investigated in the present study.
DESIGNS:

This multicentre study included 276 patients from 16 hospitals in Korea who achieved NA-induced HBsAg seroclearance: 131 (47.5%) discontinued NA treatment within 6 months after HBsAg seroclearance (NA discontinuation group) and 145 (52.5%) continued NA treatment (NA continuation group). Primary endpoint was HBsAg reversion and secondary endpoints included serum HBV DNA redetection and development of hepatocellular carcinoma (HCC).
RESULTS:

During follow-up (median=26.9 months, IQR=12.2-49.2 months), 10 patients (3.6%) experienced HBsAg reversion, 6 (2.2%) showed HBV DNA redetection and 8 (2.9%) developed HCC. Compared with NA continuation, NA discontinuation was not associated with HBsAg reversion in both univariable (HR=0.45, 95% CI=0.12 to 1.76, log-rank p=0.24) and multivariable analyses (adjusted HR=0.65, 95% CI=0.16 to 2.59, p=0.54). The cumulative probabilities of HBsAg reversion at 1, 3 and 5 years were 0.8%, 2.3% and 5.0% in the NA discontinuation group, and 1.5%, 6.3% and 8.4% in the NA continuation group, respectively. NA discontinuation was not associated with higher risk of either HBV redetection (HR=0.83, 95% CI=0.16 to 4.16, log-rank p=0.82) or HCC development (HR=0.53, 95% CI=0.12 to 2.23, log-rank p=0.38).
CONCLUSION:

The discontinuation of NA was not associated with a higher risk of either HBsAg reversion, serum HBV DNA redetection or HCC development compared with NA continuation among patients who achieved HBsAg seroclearance with NA.

© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS:

HBV DNA redetection; HBsAg; antivirals; hepatocellular carcinoma

PMID:
    32209606
DOI:
    10.1136/gutjnl-2019-320015

StephenW

肠道。 2020年3月24日。pii：gutjnl-2019-320015。 Doi：10.1136 / gutjnl-2019-320015。 [Epub提前发行]
抗病毒药诱导的HBsAg血清清除后，终止核苷酸类似物与HBsAg血清逆转的更高风险无关：一项全国性的多中心研究。
Kim MA1，Kim SU2，Sinn DH3，Jang JW4，Lim YS5，Ahn SH2，Shim JJ6，Seo YS7，Baek YH8，Kim SG9，Kim YS9，Kim JH10，Choe WH11，Yim HJ12，Lee HW13，Kwon JH14，Lee SW15 ，Jang JY16，Kim HY17，Park Y3，Kim GA6，Yang H4，Lee HA7，Koh M8，Lee YS10，Kim M12，Chang Y16，Kim YJ1，Yoon JH1，Zoulim F18，Lee JH19。
作者信息

1个
首尔国立大学医学院，首尔国立大学医院内科与肝脏研究所，韩国首尔。
2
延世大学医学院遣散医院内科和延世肝脏中心，韩国首尔。
3
成均馆大学医学院三星医学中心医学系，韩国首尔。
4
韩国天主教大学首尔市圣玛丽医院内科，韩国首尔。
5
蔚山医科大学附属大学牙山医学中心肝病中心消化科，首尔。
6
庆熙大学医学院内科，韩国首尔。
7
高丽大学医学院高丽大学安南医院内科，韩国首尔。
8
韩国釜山东亚大学医学院内科。
9
富川市淳春大学医院内科，韩国富川市淳春大学医学院。
10
高丽大学医学院高丽大学九老医院内科，韩国首尔。
11
韩国首尔建国大学医学院附属建国大学医院内科。
12
高丽大学医学院附属高丽大学安山医院内科，韩国安山。
13
延世大学医学院江南遣散医院内科学与延世肝病中心，韩国首尔。
14
韩国天主教大学仁川圣玛丽医院内科，韩国仁川。
15
韩国天主教大学富川市圣玛丽医院内科，韩国富川市。
16
首尔市淳春市大学医学院内科，韩国首尔。
17
梨花女子大学医学院内科，韩国首尔。
18岁
里昂癌症研究中心，INSERM U1052，里昂大学，里昂市政医院，法国里昂。
19
首尔国立大学医学院，首尔国立大学医院内科和肝脏研究所，韩国首尔[email protected]。

抽象
目的：

在实现HBsAg血清清除的慢性乙型肝炎患者中，未进行核苷酸类似物（NA）终止与NA延续之间临床结果的直接比较。在本研究中，研究了在NA诱导的HBV表面抗原（HBsAg）血清清除后，NA终止是否与NA连续一样安全。
设计：

这项多中心研究包括来自韩国16家医院的276例患者，这些患者实现了NA诱导的HBsAg血清清除：131（47.5％）人在HBsAg血清清除后6个月内停止NA治疗（NA停用组）和145例（52.5％）继续进行NA治疗（NA继续）组）。主要终点为HBsAg逆转，次要终点为血清HBV DNA重检测和肝细胞癌（HCC）的发展。
结果：

在随访期间（中位= 26.9个月，IQR = 12.2-49.2个月），有10例患者（3.6％）经历了HBsAg逆转，6例（2.2％）出现了HBV DNA复查，8例（2.9％）发生了HCC。与NA连续相比，NA中断与单变量（HR = 0.45，95％CI = 0.12至1.76，log-rank p = 0.24）和多变量分析（校正后HR = 0.65，95％CI = 0.16）均与HBsAg逆转无关。至2.59，p = 0.54）。 NA终止组在1、3和5年时HBsAg逆转的累积概率分别为0.8％，2.3％和5.0％，而NA终止组分别为1.5％，6.3％和8.4％。 NA停用与再次检测HBV（HR = 0.83，95％CI = 0.16至4.16，log-rank p = 0.82）或HCC发生（HR = 0.53，95％CI = 0.12至2.23，log-log等级p = 0.38）。
结论：

与通过NA实现HBsAg血清清除的患者继续进行NA相比，NA的终止与HBsAg逆转，血清HBV DNA重新检测或HCC发生的更高风险无关。

©作者（或其雇主）2020。不得商业重复使用。 查看权限。 由BMJ发布。
关键字：

HBV DNA重新检测； 乙肝表面抗原 抗病毒药 肝细胞癌

PMID：
     32209606
DOI：
     10.1136 / gutjnl-2019-320015

齐欢畅

rxsm

齐欢畅 发表于 2020-3-28 21:14

是猪肉跌了吗？