HBeAg阴性慢性乙型肝炎停用核苷酸类似物治疗后乙型肝炎发作

StephenW

Hepatitis B flare after cessation of nucleos(t)ide analogue therapy in HBeAg-negative chronic hepatitis B: To retreat or not to retreat
Yun-Fan Liaw  1
Affiliations
Affiliation

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

    PMID: 32810321 DOI: 10.1002/hep.31525

Abstract

Finite nucleos(t)ide analogue (Nuc) therapy in HBV suppressed hepatitis B e antigen (HBeAg)-negative patients with chronic hepatitis B may substantially increase hepatitis B surface antigen (HBsAg) loss rate after cessation of therapy, in which "no retreatment" is a strong predictor for HBsAg loss. However, the main safety concern of no retreatment is hepatitis flare leading to hepatic decompensation or even fatality. Hence it is crucial to make retreatment decision that is not too soon to allow sufficient immune clearance facilitating further HBsAg decline towards HBsAg loss and, more importantly, not too late to prevent adverse outcomes. This review discussed and evaluated the presentations and pathogenesis of hepatitis B flare, with emphasis on issues surrounding off-Nuc hepatitis B flare in HBeAg-negative patients. The advantage and deficiency of retreatment decision based on current biochemical marker(s) alone were reviewed. The concept of immune clearance and its clinical application of combined HBsAg/ALT kinetics during hepatitis flare in the differentiation between two types of hepatitis flare were also reviewed. The utility of combined HBsAg/ALT kinetics for retreatment decision was proposed and elaborated in detail. The feasibility, application and underlying pathobiologic mechanism(s) of this approach require further investigation. Studies on the role of immunologic and/or other viral markers in retreatment decision are also needed. In conclusion, combined qHBsAg/ALT kinetics seems to be better than current biochemical marker(s) alone in the differentiation of types of hepatitis flare for better decision that retreatment is not necessary or not too soon for "host-dominating flare" to allow sufficient immune clearance response facilitating further HBsAg decline towards HBsAg loss, and not too late for "virus-dominating flare", to prevent adverse outcome such as hepatic decompensation.

Keywords: clinical relapse; hepatitis flare type; immunopathogenesis; quantitative HBsAg; retreatment decision.

StephenW

HBeAg阴性慢性乙型肝炎停用核苷酸类似物治疗后乙型肝炎发作：退还是不退
廖云凡1
隶属关系
联系

    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。

    PMID：32810321 DOI：10.1002 / hep.31525

抽象

HBV抑制的乙型肝炎e抗原（HBeAg）阴性的慢性乙型肝炎患者的有限核苷酸（t）ide类似物（Nuc）治疗可能会在停止治疗后显着增加乙型肝炎表面抗原（HBsAg）的丢失率，其中“不予治疗” “是HBsAg丢失的有力预测指标。但是，不进行复治的主要安全隐患是肝炎发作会导致肝代偿失调甚至死亡。因此，至关重要的是要尽快做出再治疗决定，以允许足够的免疫清除，以促进HBsAg进一步下降至HBsAg丢失，更重要的是，为时不晚，以防止不良后果。这篇综述讨论并评估了乙型肝炎发作的表现和发病机理，重点是围绕HBeAg阴性患者的非NUC型乙型肝炎发作的问题。回顾了仅基于当前生化标记的再治疗决策的优缺点。还综述了免疫清除的概念及其在乙型肝炎发作期间结合HBsAg / ALT动力学在两种类型肝炎发作之间的区分中的临床应用。提出并详细阐述了结合使用HBsAg / ALT动力学进行再治疗的决策。这种方法的可行性，应用和潜在的病理生物学机制需要进一步研究。还需要研究免疫学和/或其他病毒标志物在再治疗决策中的作用。总之，在区分肝炎耀斑类型方面，qHBsAg / ALT联合动力学似乎比目前单独的生化指标好，以便更好地做出决定，对于“宿主为主的耀斑”，无需再治疗或很快治疗，就足以免疫清除反应可促进HBsAg进一步朝着HBsAg丢失的方向下降，并且对于“以病毒为主的耀斑”还为时不晚，以防止不良后果，例如肝脏代偿失调。

关键字：临床复发；肝炎爆发型免疫发病机制定量HBsAg；再治疗的决定。