肝炎爆发对HBeAg丢失的影响主要在慢性乙肝的核苷酸治疗第一

StephenW

The impact of hepatitis flare on HBeAg loss was effective mainly in the first year of Nucleot(s)ide therapy in chronic hepatitis B
Chien-Wei Peng  1   2 , Wen-Juei Jeng  1   2 , Rong-Nan Chien  1   2   3 , Yun-Fan Liaw  2   3
Affiliations
Affiliations

    1
    Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan.
    2
    College of Medicine, Chang Gung University, Taipei, Taiwan.
    3
    Liver Research Unit, Chang Gung Memorial Hospital, Taiwan.

    PMID: 33274536 DOI: 10.1111/jvh.13449

Abstract

HBeAg loss during nucleos(t)ide analogue (Nuc) therapy is significantly higher in patients with hepatitis flare (ALT≥ 5-times upper limited of normal). It is not clear whether ALT level higher above the hepatitis flare leads to greater HBeAg loss rate nor its durability. This study aimed to investigate the impact of pre-therapy ALT level on HBeAg loss in each year of Nuc treatment. Entecavir or Tenofovir treated HBeAg positive chronic hepatitis B (CHB) patients were recruited consecutively. Patients with prior treatment history that experienced HBeAg seroconversion and reversion were excluded. Pretherapy age, gender, cirrhosis, genotype, ALT, HBsAg and HBV DNA levels were analyzed. The hazard function was calculated for the probability of HBeAg loss in each year. Of the 290 patients, the 3-year cumulative HBeAg loss rate was 58.1%, higher in patients with hepatitis flare than those without (67.6% vs. 39.6%, P<0.001). The HBeAg loss rate in the first year correlated positively with higher ALT levels at a stepwise fashion. The hazard function in patients with hepatitis flare was 0.74 at half year, then dropped to 0.33 by the first year and was lower thereafter to a rate closer to that of the patients without hepatitis flare. In conclusion, the impact of pretherapy ALT levels on HBeAg loss rate was not long-lasting and was effective mainly in the first year of Nuc therapy. Strategies such as adding an immune-modulating agent may help enhance HBeAg loss rate after the first year of Nuc therapy for those who remained HBeAg positive. Word count: 249 (<250).

Keywords: HBeAg seroconversion; entecavir; hazard function; rapid decline; tenofovir.

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StephenW

肝炎爆发对HBeAg丢失的影响主要在慢性乙肝的核苷酸治疗第一年有效
彭建伟1 2，姜文瑞1 2，钱荣南1 2 3，廖云范2 3
隶属关系
隶属关系

    1个
    台湾桃园市林口分院长庚纪念医院消化内科。
    2
    长庚大学医学院，台湾台北。
    3
    台湾长庚纪念医院肝脏研究室。

    PMID：33274536 DOI：10.1111 / jvh.13449

抽象

肝炎发作的患者（ALT≥正常上限的5倍），在核苷类似物（Nuc）治疗期间HBeAg的损失明显更高。尚不清楚ALT水平高于肝炎爆发时是否会导致更高的HBeAg丢失率或持久性。这项研究旨在调查Nuc治疗每年中治疗前ALT水平对HBeAg丢失的影响。连续招募恩替卡韦或替诺福韦治疗的HBeAg阳性慢性乙型肝炎（CHB）患者。既往有HBeAg血清转化和逆转治疗史的患者被排除。分析治疗前的年龄，性别，肝硬化，基因型，ALT，HBsAg和HBV DNA水平。计算危害函数中每年HBeAg丢失的可能性。在这290名患者中，肝炎爆发患者3年累计HBeAg丢失率为58.1％，高于无肝炎患者（67.6％对39.6％，P <0.001）。第一年的HBeAg丢失率与逐步升高的ALT水平呈正相关。肝炎爆发患者的危害功能在半年时为0.74，然后在第一年下降至0.33，此后降低到接近无肝炎发作患者的风险。总之，治疗前ALT水平对HBeAg丢失率的影响不是持久的，并且主要在Nuc治疗的第一年有效。 Nuc治疗第一年后，对于仍保持HBeAg阳性的患者，采取诸如添加免疫调节剂之类的策略可能有助于提高HBeAg的丢失率。字数：249（<250）。

关键词：HBeAg血清转化；恩替卡韦危害功能；快速下降；替诺福韦。

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