Liu Chun-Jen, Huang Wen-Ling, Chen Pei-Jer, Lai Ming-Yang, Kao Jia-Horng, Chen Ding-Shinn
Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, China.
World J Gastroenterol. 2004 Dec 15;10(24):3574-8. doi: 10.3748/wjg.v10.i24.3574.
Attaining hepatitis B e antigen (HBeAg) seroconversion during lamivudine treatment is associated with fewer relapses in HBeAg-positive patients. In HBeAg-negative patients, predictors for post-treatment relapse remain largely unknown. We therefore studied whether end-of-treatment virologic response correlated with relapse after lamivudine treatment.
We prospectively analyzed 12 HBeAg-negative patients and 14 HBeAg-positive patients with chronic hepatitis B, who received at least 9 mo of lamivudine treatment and were followed up for 12 mo post-treatment. Relapse of hepatitis B activity was defined by an elevation of serum ALT level above twice the upper limit of normal as well as reappearance of serum HBV DNA by the branched DNA assay or HBeAg during the follow-up period. The serum viral loads during and at the end of treatment were further determined by a quantitative real-time polymerase chain reaction assay.
Relapse occurred in 6 (50.0%) HBeAg-negative patients within 12 mo post-treatment. Two relapsers had end-of-treatment serum viral load <1 000 copies/mL, the proportion was not significantly different from that in the 6 non-relapsers (33.3% vs 16.7%; P = 1.00). Hepatitis B virus (HBV) DNA levels did not correlate with post-treatment relapse in HBeAg-positive patients either. However, genotype C patients tended to have a lower relapse rate than genotype B patients (14.3% vs 57.9%, P = 0.08).
Our results suggest that end-of-treatment virologic response cannot predict post-treatment relapse in patients with HBeAg-negative or -positive chronic hepatitis B. The impact of HBV genotype on the response to lamivudine treatment awaits further studies.
在拉米夫定治疗期间实现乙肝e抗原（HBeAg）血清学转换与HBeAg阳性患者复发率较低相关。在HBeAg阴性患者中，治疗后复发的预测因素在很大程度上仍不清楚。因此，我们研究了治疗结束时的病毒学反应是否与拉米夫定治疗后的复发相关。
我们前瞻性分析了12例HBeAg阴性和14例HBeAg阳性的慢性乙型肝炎患者，这些患者接受了至少9个月的拉米夫定治疗，并在治疗后随访12个月。乙肝活动复发的定义为随访期间血清ALT水平升高至正常上限的两倍以上，以及通过分支DNA测定法或HBeAg再次出现血清HBV DNA。治疗期间及结束时的血清病毒载量通过定量实时聚合酶链反应测定法进一步确定。
6例（50.0%）HBeAg阴性患者在治疗后12个月内复发。2例复发患者治疗结束时血清病毒载量<1000拷贝/mL，该比例与6例未复发患者的比例无显著差异（33.3%对16.7%；P = 1.00）。乙肝病毒（HBV）DNA水平与HBeAg阳性患者治疗后的复发也无关。然而，C基因型患者的复发率往往低于B基因型患者（14.3%对57.9%，P = 0.08）。
我们的结果表明，治疗结束时的病毒学反应不能预测HBeAg阴性或阳性慢性乙型肝炎患者治疗后的复发。HBV基因型对拉米夫定治疗反应的影响有待进一步研究。
