结合乙型肝炎病毒RNA和乙型肝炎核心相关抗原：安全停止乙

StephenW

Combining Hepatitis B Virus RNA and Hepatitis B Core–Related Antigen: Guidance for Safely Stopping Nucleos(t)ide Analogues in Hepatitis B e Antigen–Positive Patients With Chronic Hepatitis B
Rong Fan, Jie Peng, Qing Xie, Deming Tan, Min Xu, Junqi Niu, Hao Wang, Hong Ren, Xinyue Chen, Maorong Wang, Jifang Sheng, Hong Tang, Xuefan Bai, Yaobo Wu, Bin Zhou, Jian Sun, Jinlin Hou, for the Chronic Hepatitis B Study Consortium
The Journal of Infectious Diseases, Volume 222, Issue 4, 15 August 2020, Pages 611–618, https://doi.org/10.1093/infdis/jiaa136
Published:
25 March 2020
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Abstract
Background

Safe nucleos(t)ide analogue discontinuation in chronic hepatitis B (CHB) is an unmet need. We aimed to investigate whether combining hepatitis B virus (HBV) RNA and hepatitis B core–related antigen (HBcrAg) could perform satisfactorily in predicting off-treatment outcomes.
Methods

The evaluation cohort included 127 hepatitis B e antigen (HBeAg)–positive patients from a multicenter prospective trial who stopped telbivudine-based therapy after achieving HBeAg seroconversion and HBV DNA < 50 IU/mL for > 48 weeks. As validation, 59 patients treated with entecavir or tenofovir before discontinuation were analyzed.
Results

At the end of treatment (EOT), HBV RNA and HBcrAg were significant independent predictors of the clinical relapse risk. In the evaluation cohort, no clinical relapse occurred among patients with negative HBV RNA and HBcrAg < 4 log10 U/mL at EOT (low-risk group), whereas 46.8% patients with positive HBV RNA and HBcrAg ≥ 4 log10 U/mL (high-risk group) experienced clinical relapse during 4-year posttreatment follow-up (P < .001); the corresponding incidences in the validation cohort were 0% and 69.4% (P < .001), respectively. More patients in the low-risk group achieved HBsAg loss than the other patients after treatment cessation (16.1% vs 1.3%, P = .002).
Conclusions

Combining HBV RNA and HBcrAg performed satisfactorily in predicting clinical relapse and HBsAg loss after treatment cessation in HBeAg-positive patients with CHB.

The combination of hepatitis B virus RNA and hepatitis B core–related antigen performed satisfactorily in predicting clinical relapse and hepatitis B surface antigen loss after stopping nucleos(t)ide analogue treatment among noncirrhotic hepatitis B e antigen–positive patients with chronic hepatitis B and could be used to guide safe discontinuation.
discontinuation, clinical relapse, HBsAg loss, biomarker
Topic:

    hepatitis b antigens hepatitis b e antigens hepatitis b surface antigens hepatitis b, chronic hepatitis b virus rna

Issue Section:
Viruses

StephenW

结合乙型肝炎病毒RNA和乙型肝炎核心相关抗原：安全停止乙型肝炎e抗原阳性慢性乙型肝炎患者的核苷类似物的指南
范帆，彭杰，谢庆，谭德明，徐敏，牛俊奇，王浩，洪仁，陈新月，王茂荣，季继生，洪棠，白雪凡，吴耀波，周斌，孙建，侯金林，用于慢性乙型肝炎研究联盟
传染病杂志，222卷，第四期，2020年8月15日，第611-618页，https://doi.org/10.1093/infdis/jiaa136
发布时间：
2020年3月25日
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抽象
背景

慢性乙型肝炎（CHB）中安全的核苷酸（t）ide类似物停用尚待满足。我们旨在研究将乙型肝炎病毒（HBV）RNA与乙型肝炎核心相关抗原（HBcrAg）结合在预测非治疗结局方面能否令人满意。
方法

该评估队列包括来自多中心前瞻性研究的127例乙型肝炎e抗原（HBeAg）阳性患者，这些患者在达到HBeAg血清转化和HBV DNA <50 IU / mL≥48周后停止了基于替比夫定的治疗。作为确认，分析了停药前用恩替卡韦或替诺福韦治疗的59例患者。
结果

在治疗结束（EOT）时，HBV RNA和HBcrAg是临床复发风险的重要独立预测因子。在评估队列中，EOT时HBV RNA阴性且HBcrAg <4 log10 U / mL的患者（低危组）未发生临床复发，而HBV RNA阳性且HBcrAg≥4log10 U / mL的患者中有46.8％的患者复发（高-高风险组）在治疗后4年的随访期间经历了临床复发（P <.001）；验证队列中的相应发生率分别为0％和69.4％（P <0.001）。低风险组中HBsAg丢失的患者比停止治疗后的其他患者多（16.1％比1.3％，P，= 0.002）。
结论

HBV RNA和HBcrAg的结合在预测HBeAg阳性CHB患者停止治疗后的临床复发和HBsAg丢失方面令人满意。

在慢性乙型肝炎的非乙型肝炎e抗原阳性患者中，停止核苷酸类似物治疗后，乙肝病毒RNA和乙肝核心相关抗原的结合可令人满意地预测临床复发和乙肝表面抗原的丢失，并且可以用于指导安全停产。
停药，临床复发，HBsAg丢失，生物标志物
话题：

    乙型肝炎抗原乙型肝炎e抗原乙型肝炎表面抗原乙型肝炎，慢性乙型肝炎病毒

发行部分：
病毒