慢性 HBV 感染病毒抑制患者口服核苷（酸）类似物戒断的循证

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慢性 HBV 感染病毒抑制患者口服核苷（酸）类似物戒断的循证管理

    Ming-Ling Chang、Rong-Nan Chien 和 Yun-Fan Liaw

Current Hepatology Reports 第 21 卷，第 52–58 页（2022 年）引用这篇文章

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抽象的
审查目的

有限Nuc疗法的策略在全球范围内越来越被接受。如何管理 HBV 抑制患者的 Nuc 戒断已成为一个重要问题。本综述旨在提供一种循证方法。
最近的发现

HBV 抑制可能在 Nuc 停止后持续，发生率越高，治疗结束时 HBsAg 水平越低。停用 Nuc 后可能会出现临床复发和肝炎发作，2 年的发生率分别为 60% 和 42%。及时再治疗可以预防/挽救肝功能失代偿的恶化，尽管非肝硬化患者的发生率几乎为 0，而“不再治疗”是 HBsAg 消失的一个重要因素。
概括

Nuc 停止后的适当监测对于及时复治以确保安全至关重要。不进行再治疗或不太早进行再治疗可能会导致宿主对 HBsAg 的免疫清除反应进一步下降，从而导致 HBsAg 消失。正确使用生化标准，尤其是结合 HBsAg/ALT 动力学，可能有助于做出正确的再治疗决策。

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Evidence-Based Management of Oral Nucleos(t)ide Analogue Withdrawal in Virally Suppressed Patients with Chronic HBV Infection

    Ming-Ling Chang, Rong-Nan Chien & Yun-Fan Liaw 

Current Hepatology Reports volume 21, pages 52–58 (2022)Cite this article

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Abstract
Purpose of Review

The strategy of finite Nuc therapy has been increasingly accepted globally. How to manage Nuc withdrawal in HBV-suppressed patients has become an important issue. This review aimed to provide an evidence-based approach.
Recent Findings

HBV suppression may sustain after Nuc cessation at an incidence the higher the lower the end of therapy HBsAg level. Clinical relapse and hepatitis flare may occur after Nuc cessation at a 2-year incidence of 60% and 42%, respectively. Timely retreatment may prevent/rescue deterioration to hepatic decompensation albeit at an incidence of almost 0 in non-cirrhotic patients, whereas “no retreatment” is an important factor for HBsAg loss.
Summary

Proper monitoring after Nuc cessation is crucial for timely retreatment to ensure safety. No retreatment or not too early retreatment may allow further host immune clearance response for HBsAg decline toward HBsAg loss. Proper utilization of biochemical criteria, especially combined HBsAg/ALT kinetics, may help proper retreatment decision.