哪些因素可预测儿童慢性乙型肝炎停止抗病毒治疗后复发？

StephenW

哪些因素可预测儿童慢性乙型肝炎停止抗病毒治疗后复发？
昨天
NVR 3-778 一流的乙肝治疗

一项研究表明，近三分之一的慢性乙型肝炎 (CHB) 儿童停止抗病毒治疗后复发。

复发在乙型肝炎 e 抗原 (HBeAg) 阳性患者和需要更长时间治疗乙型肝炎病毒 - 脱氧核糖核酸 (HBV-DNA) 变得无法检测到的患者中更为常见。

在这项研究中，作者招募了所有入院的乙型肝炎表面抗原（HBsAG）阳性儿童，这些儿童已经接受了至少 2 年的抗病毒治疗，且 HBV-DNA 和丙氨酸氨基转移酶（ALT）连续 3 次检测不到。过去 12 个月。

如果肝活检显示组织学活动指数 <5 和纤维化 (Ishak) <3，则停止抗病毒治疗。

病毒学复发是指 HBV-DNA 升高（>2,000 IU/mL），而生化复发被定义为 ALT 水平升高至正常上限的 2 倍以上。生化复发的儿童开始接受基于聚乙二醇干扰素 α-2b 的序贯治疗。

114 名 CHB 儿童接受了筛查，其中 31 名 HBsAG 阳性符合入选标准并停止抗病毒治疗。 12 名儿童 (38.7%) 出现病毒学复发，而 5 名儿童 (16.1%) 在停止抗病毒治疗后 12 个月内出现生化复发。

Cox 回归显示，复发由以下变量独立预测：停止抗病毒治疗时 HBeAg 阳性状态（风险比 [HR]，6.208，95% 置信区间 [CI]，1.630-23.638）和 HBV 花费的时间更长- 在使用抗病毒药物时，DNA 变得无法检测到（HR，1.027，95% CI，1.000-1.055）。
儿科感染病学杂志 2022；41:714-719

StephenW

Which factors predict relapse after antiviral therapy cessation in paediatric CHB?
Yesterday
NVR 3-778 first in class hepatitis B treatment

Nearly one in three children with chronic hepatitis B (CHB) who discontinued their antiviral treatment has relapsed, a study has shown.

Relapse is more common among hepatitis B e antigen (HBeAg)-positive patients and in those who need longer therapy for hepatitis B virus-deoxyribonucleic acid (HBV-DNA) to become undetectable.

In this study, the authors enrolled all hepatitis B surface antigen (HBsAG)-positive children admitted to the hospital who had been on antiviral therapy for at least 2 years with undetectable HBV-DNA and normal alanine aminotransferase (ALT) on three consecutive occasions over the last 12 months.

Treatment with antivirals was discontinued if liver biopsy showed histological activity index <5 and fibrosis (Ishak) <3.

Virological relapse referred to the elevation of HBV-DNA (>2,000 IU/mL), while biochemical relapse was defined as a rise in ALT levels to >2 times the upper limit of normal. Children with biochemical relapse were initiated on pegylated interferon alpha-2b-based sequential therapy.

One hundred fourteen children with CHB underwent screening, of which 31 who were HBsAG-positive met the eligibility criteria and stopped antiviral treatment. Twelve children (38.7 percent) had virological relapse, while five (16.1 percent) had biochemical relapse within 12 months of antiviral therapy discontinuation.

Cox regression revealed that relapse was independently predicted by the following variables: HBeAg positive status at the time of stopping antiviral therapy (hazard ratio [HR], 6.208, 95 percent confidence interval [CI], 1.630‒23.638) and longer time taken for HBV-DNA to become undetectable while on antivirals (HR, 1.027, 95 percent CI, 1.000‒1.055).
Pediatr Infect Dis J 2022;41:714-719