AASLD2020[802]802 核外HBEAG阴性的长期结果 使用序贯HBsAg动力学的

StephenW

802
LONG-TERM OUTCOME IN OFF-NUC HBEAG NEGATIVE
PATIENTS USING SEQUENTIAL HBsAg KINETICS TO MAKE
RETREATMENT DECISION
Wen-Juei Jeng1,2,3, Yen-Chun Liu2,3,4, Chien-Wei Peng2,5,
Rong-Nan Chien2,3 and Yun-Fan Liaw2,3,4,6, (1)Department of
Gastroenterology and Hepatology, Chang Gung Memorial
Hospital, Linkou, Taiwan, (2)College of Medicine, Chang
Gung University, Taiwan, (3)Department of Gastroenterology
and Hepatology, Chang Gung Memorial Hospital, Linkou
Branch, Taiwan, (4)Department of Gastroenterology and
Hepatology, Chang Gung Memorial Hospital, Linkou Branch,
(5)Department of Gastroenterology and Hepatology, Chang
Gung Memorial Hospital, Linkou, (6)Liver Research Unit,
Chang Gung Memorial Hospital, Linkou, Taiwan
Background: Retrospective appraisal of the timing of
retreatment in patients with different types of hepatitis flare
reflecting effective or ineffective endogenous immune
response However, the long-term outcomes of patients with
different immune response (effective or ineffective immune
clearance) with and without retreatment remain unknown
This study aims to clarify the impact of retreatment in effective
and ineffective flare patients comparing to the outcome in the
untreated patients Methods: A nested case-control study
was conducted in 336 retreated and 105 un-retreated HBeAgnegative
patients with off-therapy hepatitis flare. HBsAg was
quantified before and during flare, at ALT peak or retreatment
start, month 6 and 12. Hepatitis flare with increasing HBsAg
prior to retreatment or ALT peak was classified as “virus dominating
flare” whereas flare with decreasing HBsAg
as “host-dominating flare”. Results: Of the retreated
patients, 85.7% showed virus-dominating flare and 14.3%
host-dominating flare. Patients with virus-dominating flare
showed greater HBsAg decline (-1 0 vs -0 01 log10IU/mL,
P<0 0001) with more frequent rapid decline (69 8 vs 8 3%;
P<0000) by month 12 and 3-year incidence of achieving
HBsAg <100 IU/mL (33 vs 13%, P=0 039) during entecavir or
tenofovir retreatment Notably, one-third of patients with hostdominating
flare showed on-retreatment HBsAg rebound over
pre-retreatment level (vs 1 4%; P<0 0001) Compared with
un-retreated controls, 1-year HBsAg decline was greater (-1 0
vs -0 47 log10IU/mL; P<0 0001) and faster (69 8 vs 42 5%;
P<0.0001) in retreated patients with virus-dominating flare.
Conversely, 1-year HBsAg decline (-0 01 vs -0 16 log10IU/mL)
and 3-year HBsAg loss rate (0 vs 21%; P=0 009) were lower
in retreated than un-retreated patients with host-dominating
flare. Conclusion: Oral anti-HBV retreatment is effective in
patients with virus-dominating flare but ineffective or even
worsen in patients with host-dominating flare. These results
validate the concept using combined HBsAg/ALT kinetic for
decision to retreat patients with virus-dominating flare and
to hold retreatment and watch carefully in patients with hostdominating
flare.

StephenW

802
核外HBEAG阴性的长期结果
使用序贯HBsAg动力学的患者
修复决策
曾文瑞1,2,3，刘延春2,3,4，彭建伟2,5，
钱荣南2,3和Yun-Fan Liaw2,3,4,6，（1）
肠胃病和肝病，长庚纪念馆
台湾林口医院（2）医学院
台湾工大，（3）肠胃科
林口长庚纪念医院肝内科
台湾分公司（4）消化内科
长口纪念医院林口分院肝病科
（5）常德胃肠病学
林口贡纪念医院（6）肝病研究室
台湾林口市长庚纪念医院
背景：回顾性评估的时机
不同类型肝炎发作的患者再次治疗
反映有效或无效的内源性免疫
反应但是，患者的长期结局
不同的免疫反应（有效或无效免疫
清除）是否进行再治疗仍然未知
这项研究旨在阐明重新治疗对有效治疗的影响。
与没有效果的耀斑患者相比
未经治疗的患者方法：嵌套病例对照研究
在336例退缩和105例未退缩的HBe中进行
非治疗性肝炎发作的患者。 HBsAg原为
在爆发前和爆发期间，ALT高峰或复治时进行定量
从第6和12月开始。HBsAg升高引起的肝炎发作
复治前或ALT高峰被归类为“病毒占主导地位”
爆发”，而HBsAg降低的爆发
作为“主宰火炬”。结果：退缩
患者中，有85.7％的人表现出以病毒为主的耀斑，而14.3％
宿主主导的耀斑。病毒为主的患者
HBsAg下降幅度更大（-1 0 vs -0 01 log10IU / mL，
P <0 0001），快速下降的频率更高（69 8 vs 8 3％；
P <0000），在第12个月和3年内达到的发生率
恩替卡韦或治疗期间HBsAg <100 IU / mL（33 vs 13％，P = 0 039）
替诺福韦再治疗值得注意的是，三分之一的宿主占主导地位
爆发显示治疗中HBsAg反弹超过
再治疗前水平（vs 1 4％; P <0 0001）与
未经治疗的对照者，一年HBsAg下降幅度更大（-1 0
vs -47 log10IU / mL; P <0 0001）和更快（69 8 vs 42 5％;
P <0.0001）在以病毒为主的耀斑治疗的复发患者中。
相反，一年HBsAg下降（-0 01 vs -0 16 log10IU / mL）
和3年HBsAg丢失率（0比21％； P = 0 009）更低
接受治疗的患者比未接受治疗的患者占主导地位
耀斑。结论：口服抗乙肝病毒治疗可有效治疗
病毒为主的耀斑患者，但无效甚至
宿主为主的耀斑患者病情恶化。这些结果
结合使用HBsAg / ALT动力学验证概念
决定撤退具有病毒主导性耀斑的患者
对主要宿主患者进行复治并仔细观察
耀斑。