两种类型的乙型肝炎发作患者之间 HBsAg 动力学的高度显着差

StephenW

两种类型的乙型肝炎发作患者之间 HBsAg 动力学的高度显着差异，有和没有再治疗
Wen-Jei Jeng 1 2 , Yen-Chun Liu 1 2 , Chien-Wei Peng 1 2 , Rong-Nan Chien 1 2 3 , Yun-Fan Liaw 1 3
隶属关系
隶属关系

    1
    台湾桃园长庚大学医学院。
    2
    台湾桃园市林口分院长庚医院消化内科及肝病科。
    3
    台湾桃园长庚医院肝脏研究室。

    PMID：34618028 DOI：10.1093/jac/dkab360

抽象的

背景：非治疗肝炎爆发可能是有害的，或者相反，促进乙型肝炎表面抗原 (HBsAg) 下降。再治疗决策至关重要。

方法：对 336 名接受恩替卡韦/替诺福韦治疗和 105 名未接受治疗的乙型肝炎 e 抗原 (HBeAg) 阴性患者的 HBsAg 进行量化，分别在突发之前和期间、峰值/重新治疗开始时以及第 6 个月和第 12 个月。 ALT 爆发期间 HBsAg 增加定义为“病毒主导的爆发”，而 HBsAg 降低定义为“宿主主导的爆发”。

结< 0001) 和 HBsAg < 100 IU/mL 的 3 年发病率（32% 对 12%；P = 0.026）高于 48 名以宿主为主的耀斑患者，其中 16 名（33.3%）显示 3.8 倍（2 至52 倍）HBsAg 在再治疗后反弹（对比 2/288；P < 0.0001）。与未治疗的对照组相比，以病毒为主的爆发患者的 1 年 HBsAg 下降幅度更大（-1.0 对 -0.47 log10 IU/mL；P < 0.0001）和更快（69.8% 对 42.5%；P < 0.0001），而宿主主导的耀斑患者 1 年 HBsAg 下降（-0.01 对 -0.16 log10 IU/mL）和 3 年 HBsAg 消失率（0% 对 21%；P = 0.009）较低。

结论：恩替卡韦/替诺福韦再治疗可有效降低病毒主导的爆发患者的 HBsAg 水平，但对宿主主导的爆发患者无效/更糟。这些结果支持使用联合 HBsAg/ALT 动力学来决定对病毒主导的爆发患者进行再治疗，而对宿主主导的爆发患者不进行再治疗。

© The Author(s) 2021。由牛津大学出版社代表英国抗微生物化疗学会出版。版权所有。如需许可，请发送电子邮件至：[email protected]。

StephenW

Highly significant differences in HBsAg kinetics among patients with two types of hepatitis B flare, with and without retreatment
Wen-Juei Jeng  1   2 , Yen-Chun Liu  1   2 , Chien-Wei Peng  1   2 , Rong-Nan Chien  1   2   3 , Yun-Fan Liaw  1   3
Affiliations
Affiliations

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

    PMID: 34618028 DOI: 10.1093/jac/dkab360

Abstract

Background: Off-therapy hepatitis flare may be detrimental or, conversely, facilitate hepatitis B surface antigen (HBsAg) decline. Retreatment decisions are crucial.

Methods: HBsAg was quantified before and during flares, at peak/retreatment start and at Months 6 and 12 in 336 entecavir/tenofovir-retreated and 105 non-retreated hepatitis B e antigen (HBeAg)-negative patients. Increasing HBsAg during ALT flare defined a 'virus-dominating flare' and decreasing HBsAg a 'host-dominating flare'.

Results: Two hundred and eighty-eight retreated patients with a virus-dominating flare showed greater 1 year HBsAg decline (-1.0 versus -0.01 log10 IU/mL; P < 0.0001), more frequent rapid decline (69.8% versus 8.3%; P < 0001) and higher 3 year incidence of HBsAg < 100 IU/mL (32% versus 12%; P = 0.026) than 48 patients with a host-dominating flare, of whom 16 (33.3%) showed 3.8-fold (2 to 52-fold) HBsAg rebound on retreatment (versus 2/288; P < 0.0001). Compared with non-retreated controls, 1 year HBsAg decline was greater (-1.0 versus -0.47 log10 IU/mL; P < 0.0001) and faster (69.8% versus 42.5%; P < 0.0001) in patients with a virus-dominating flare, whereas 1 year HBsAg decline (-0.01 versus -0.16 log10 IU/mL) and 3 year HBsAg loss rate (0% versus 21%; P = 0.009) were lower in patients with a host-dominating flare.

Conclusions: Entecavir/tenofovir retreatment effectively decreases HBsAg level in patients with a virus-dominating flare but is ineffective/worse in patients with a host-dominating flare. These results support the use of combined HBsAg/ALT kinetics for the decision to retreat patients with a virus-dominating flare and withhold retreatment for patients with a host-dominating flare.

© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: [email protected].