联合使用治疗结束时的HBsAg和基线乙型肝炎核心相关抗原可降

StephenW

Combining end-of-treatment HBsAg and baseline hepatitis B core-related antigen reduce HBV relapse rate after tenofovir cessation
Yuan-Hung Kuo  1 , Jing-Houng Wang  1 , Chao-Hung Hung  1 , Sheng-Nan Lu  1 , Tsung-Hui Hu  2 , Chien-Hung Chen  3
Affiliations
Affiliations

    1
    Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Rd, Niao-Sung 833, Kaohsiung City, Taiwan.
    2
    Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Rd, Niao-Sung 833, Kaohsiung City, Taiwan. [email protected].
    3
    Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Rd, Niao-Sung 833, Kaohsiung City, Taiwan. [email protected].

    PMID: 33665773 DOI: 10.1007/s12072-021-10159-w

Abstract

Background/purpose: The study investigated the role of hepatitis B core-related antigen (HBcrAg) in hepatitis B virus (HBV) relapse after stopping tenofovir disoproxil fumarate (TDF) in HBeAg-negative patients.

Methods: A total of 185 HBeAg-negative patients without cirrhosis who had stopped TDF treatment for at least 6 months were recruited. All patients fulfilled the stopping criteria proposed by the Asian Pacific Association for the Study of the Liver 2012.

Results: The 3-year cumulative incidences of virological relapse, clinical relapse, and hepatitis B surface antigen (HBsAg) loss were 72, 60.1 and 14.5%, respectively. End-of-treatment (EOT) HBsAg level was an independent predictor of virological relapse (hazard ratio (HR): 2.263; 95% confidence interval (CI): 1.779-2.887), clinical relapse (HR 1.773; 95% CI 1.367-2.298), and HBsAg loss (HR 0.179; 95% CI 0.096-0.335). Among patients who had HBsAg < 100 and ≥ 100 IU/mL, the 3-year virological relapse rates were 37.4% and 85.3% (p < 0.001), clinical relapse rates were 30.3 and 71.7% (p < 0.001), and HBsAg loss rates were 40.6 and 2.6% (p < 0.001), respectively. Among the 53 patients with EOT HBsAg level < 100 IU/mL, the 3-year virological relapse rates in patients with baseline HBcrAg levels < 4.7 and ≥ 4.7 log10 U/mL were 20.3 and 60.4% (p = 0.003), and the clinical relapse rates were 10.3 and 59.5% (p < 0.001) respectively. Additionally, the 3-year HBsAg loss rates in patients with baseline HBcrAg ≤ 3 and > 3 log10 U/mL were 42.9 and 7.9% (p < 0.001).

Conclusions: The combination of EOT HBsAg and baseline HBcrAg levels could further reduce the risk of HBV relapse after stopping TDF therapy in HBeAg-negative patients.

Keywords: Alanine aminotransferase; Chronic hepatitis B; Cirrhosis; Clinical relapse; Hepatitis B core-related antigen; Hepatitis B e antigen; Hepatitis B surface antigen; Hepatitis B virus; Tenofovir disoproxil fumarate; Virological relapse.

StephenW

联合使用治疗结束时的HBsAg和基线乙型肝炎核心相关抗原可降低Tenofovir停用后的HBV复发率
郭元洪1，王静红1，洪朝红1，卢圣南1，胡宗辉2，陈建鸿3
隶属关系
隶属关系

    1个
    高雄市长庚纪念医院和长庚大学医学院内科肝消化肠内科，台湾高雄市鸟歌833号大培路123号。
    2个
    高雄市长庚纪念医院和长庚大学医学院内科肝消化肠内科，台湾高雄市鸟歌833号大培路123号。 [email protected]。
    3
    高雄市长庚纪念医院和长庚大学医学院内科肝消化肠内科，台湾高雄市鸟歌833号大培路123号。 [email protected]。

    PMID：33665773 DOI：10.1007 / s12072-021-10159-w

抽象的

背景/目的：该研究调查了在HBeAg阴性患者中停用替诺福韦富马酸替诺福韦（TDF）后乙型肝炎核心相关抗原（HBcrAg）在乙型肝炎病毒（HBV）复发中的作用。

方法：总共招募了185名无肝硬化的HBeAg阴性患者，他们停止了TDF治疗至少6个月。所有患者均符合亚洲太平洋肝病研究协会2012年提出的停止标准。

结果：病毒学复发，临床复发和乙型肝炎表面抗原（HBsAg）丢失的3年累积发生率分别为72、60.1和14.5％。治疗结束（EOT）HBsAg水平是病毒学复发（危险比（HR）：2.263; 95％置信区间（CI）：1.779-2.887），临床复发（HR 1.773; 95％CI 1.367- 2.298）和HBsAg丢失（HR 0.179； 95％CI 0.096-0.335）。在HBsAg <100和≥100 IU / mL的患者中，3年病毒学复发率分别为37.4％和85.3％（p <0.001），临床复发率分别为30.3和71.7％（p <0.001），以及HBsAg丢失比率分别为40.6和2.6％（p <0.001）。在53例EOT HBsAg水平<100 IU / mL的患者中，基线HBcrAg水平<4.7和≥4.7 log10 U / mL的患者的3年病毒学复发率分别为20.3和60.4％（p = 0.003），复发率分别为10.3和59.5％（p <0.001）。此外，基线HBcrAg≤3和> 3 log10 U / mL的患者的3年HBsAg丢失率分别为42.9％和7.9％（p <0.001）。

结论：EOT HBsAg和基线HBcrAg水平的组合可进一步降低HBeAg阴性患者停止TDF治疗后HBV复发的风险。

关键词：丙氨酸氨基转移酶；慢性乙型肝炎；肝硬化；临床复发；乙肝核心相关抗原；乙型肝炎e抗原；乙型肝炎表面抗原；乙型肝炎病毒;替诺福韦酯富马酸二甲吡酯；病毒学复发。