HBeAg血清学转换对核苷(酸)类似物治疗慢性乙型肝炎患者停药后复发的影响

梁延秀; 江建宁; 苏明华; 郭稳稳; 黄小红; 刘志红; 谢榕; 符武岛; 何丽霞; 钟少华

HBeAg血清学转换对核苷(酸)类似物治疗慢性乙型肝炎患者停药后复发的影响

1. 广西医科大学第一附属医院
2. 广西壮族自治区民族医院

基金项目:

广西自然科学基金(2010GXNSFD013046、桂科自0832117、桂科自0542092)；广西医学科学实验中心开放基金资助项目(KFJJ2010-20)；

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中图分类号: R512.62
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出版历程
- 出版日期: 2011-12-20

Influence of HBeAg seroconversion on virological relapse in chronic hepatitis B patients on withdrawal of nucleos (t) ide analogues therapy

Research funding:

摘要

摘要: 目的探讨HBeAg血清学转换对核苷（酸）类似物治疗慢性乙型肝炎（CHB）患者停药后复发的影响。方法回顾性分析60例HBeAg阳性接受核苷（酸）类似物治疗的CHB患者,疗程至少1年的停药患者,于基线、治疗后每个月、HBV DNA转阴后每3个月检测ALT,HBV DNA,HBeAg和抗-HBe。停药后继续随访至少6个月,观察停药后复发情况。分析停药时是否发生HBeAg消失/转换对复发的影响;比较发生HBeAg/抗HBe血清转换后巩固治疗≤12个月、12～24个月、>24个月三组患者的复发率。结果 60例患者中,60%（36例）的患者在停药后6个月内复发。8例患者未发生HBeAg消失（A组）,停药后4个月内100%复发;6例患者发生HBeAg消失,但无抗-HBe（B组）,停药后6个月内83.3%（5例）复发;46例发生HBeAg血清学转换（C组）,停药后6个月内50%（23例）复发,χ2=11.585,P=0.003,A组与C组相比,χ2=6.84,P=0.015,差异有统计学意义;B组与A组、C组相比,χ2=1.333,P=0.248,χ2=2.327,P=0.199,差异无统计学意...
- 肝炎,乙型,慢性 /
- 肝炎e抗原,乙型 /
- 复发
Abstract: Objective To explore the influence of HBeAg seroconversion on virological relapse in HBeAg-positive chronic hepatitis B patients who stopped nucleos (t) ide analogues therapy.Methods We retrospectively studied 60 HBeAg-positive chronic hepatitis B (CHB) patients who had stopped nucleos (t) ide analogues therapy.The total duration of treatment was ≥ 12 months.ALT, HBV DNA and HBV serological markers were measured respectively at baseline, every month before HBV DNA<1.0×103copies/ml, and every 3 month after HBV DNA<1.0×103copies/ml.After the drug withdrawal, we continued to follow up for at least 6 months, to observe whether or not there were relapse.HBeAg loss/seroconversion occurred at the end of the therapy were analyzed for relapse.For those patients who had HBeAg seroconversion, relapse rates in 3 groups according to duration of additional treatment (≤ 12 months, 12-24 months, > 24 months) were compared.Results Of 60 patients, 60% (36cases) relapsed within 6 months.8 cases were without HBeAg loss (A) , 100% relapsed within 4 months after drug withdrawal;6 cases occurred HBeAg loss but without HBeAb (B) , 83.3% (5 cases) relapsed within 6 months;46 cases occurred HBeAg seroconversion (C) , 50% (23 cases) relapsed within 6 months, χ2=11.585, P=0.003.There was statistical significance between A group and C group, χ2=6.84, P=0.015;But there was no statistical significance between B group and A group, χ2=1.333, P=0.248, and between B group and C group, χ2=2.327, P=0.199;For 46 patients who occurred HBeAg seroconversion, patients were assigned to the 3 groups (A, B, C) ≤ 12 months (11cases) , 12-24 months (23cases) , > 24 months (12cases) respectively.The relapse rates of group A, B, and C at 6 months were 100% (11cases) , 47.8% (11cases) , 8.3% (1case) respectively, χ2=19.377, P=0.000.There was statistical significance between A group and B group, χ2=8.609, P=0.003;between A group and C group, χ2=19.326, P=0.000;between B group and C group, χ2=5.303, P=0.027.Conclusion HBeAg seroconversion can be seen as a basic end point in the treatment of chronic hepatitis B.when duration of additional treatment after HBeAg seroconversion are ≤ 12 months, relapse rate after drug withdrawal is still high.If the duration of additional treatment after HBeAg seroconversion are > 24 months, it is expected to gain sustained virological response, but all patients should be closely followed up within 6 months after the drug withdrawal.
- hepatitis B /
- chronic /
- hepatitis B e antigens

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参考文献(6)

[1] 中华医学会.慢性乙型肝炎防治指南[J].肝脏, 2005, 10 (4) :348-357.

[2]Song BC, Suh DJ, Chung YH, et al.Hepatitis B e antigen seroconversion after lamivudine therapy is not durable in pa-tients with chronic hepatitis B in Korea[J].Hepatology, 2000, 32 (4) :803-806.

[3]Kuo YH, Chen CH, Wang JH, et al.Extended lamivudine consolidation therapy in hepatitis B e antigen-positive chro-nic hepatitis B patients improves sustained hepatitis B e anti-gen seroconversion[J].Scand J Gastroenterol, 2010, 45 (1) :75-81.

[4]Ryu SH, Chung YH, Choi MH, et al.Long-term additional lamivudine therapy enhances durability of lamivudine-induced HBeAg loss:a prospective study[J].J Hepatol, 2003, 39 (4) :614-619.

[5]马艳丽, 任万华, 主余华, 等.定量检测乙型肝炎病毒cccDNA的临床意义[J].临床检验杂志, 2006, 24 (1) :48-52.

[6]Reijnders JG, Perquin MJ, Zhang N, et al.Nucleos (t) ide analogues only induce temporary hepatitis B e antigen sero-conversion in most patients with chronic hepatitis B[J].Gastroenterology, 2010, 139 (2) :491-498.

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