Byun Kwan Soo, Kwon Oh Sang, Kim Ju Hyun, Yim Hyung Joon, Chang Yun Jung, Kim Jin Yong, Yeon Jong Eun, Park Jong Jae, Kim Jae Seon, Bak Young Tae, Lee Chang Hong
Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
J Gastroenterol Hepatol. 2005 Dec;20(12):1838-42. doi: 10.1111/j.1440-1746.2005.03952.x.
It is uncertain if a patient's lamivudine response after HBeAg loss is durable. In Korean chronic hepatitis B patients, the relapse rate is high after termination of lamivudine therapy for patients with HBeAg loss. We evaluated the factors related to relapse in chronic hepatitis B patients with HBeAg loss after lamivudine therapy.
A total of 132 chronic hepatitis B patients, who initially had HBeAg and did not have decompensated features, were analyzed in this study. These patients lost the HBeAg after lamivudine therapy and then their therapy was stopped. Post-treatment serum alanine aminotransferase (ALT), HBeAg, anti-HBe and hepatitis B virus (HBV) DNA were monitored until relapse.
Seventy-five patients relapsed (cumulative relapse rate: 56% at 6 months). Upon univariate analysis, the factors of age, serum total bilirubin, presence of anti-HBe after HBeAg loss, and the duration of additional lamivudine therapy after HBeAg loss were associated with relapse. Upon multivariate analysis, older age, a higher serum total bilirubin and the shorter duration of additional lamivudine therapy were significant risk factors for relapse. Patterns of relapse were the re-elevation of ALT, re-emergence of HBV DNA (69 patients) and reappearance of HBeAg (55 patients).
To prevent relapse in patients with chronic hepatitis B infection after lamivudine therapy, age and serum bilirubin level of patients as well as a prolonged duration of additional lamivudine therapy should be considered.
HBeAg消失后患者对拉米夫定的反应是否持久尚不确定。在韩国慢性乙型肝炎患者中，拉米夫定治疗终止后，HBeAg消失的患者复发率较高。我们评估了拉米夫定治疗后HBeAg消失的慢性乙型肝炎患者复发的相关因素。
本研究共分析了132例最初有HBeAg且无失代偿特征的慢性乙型肝炎患者。这些患者在拉米夫定治疗后HBeAg消失，随后停止治疗。监测治疗后血清丙氨酸氨基转移酶（ALT）、HBeAg、抗-HBe和乙型肝炎病毒（HBV）DNA直至复发。
75例患者复发（6个月时累积复发率：56%）。单因素分析显示，年龄、血清总胆红素、HBeAg消失后抗-HBe的存在以及HBeAg消失后额外拉米夫定治疗的持续时间与复发有关。多因素分析显示，年龄较大、血清总胆红素较高以及额外拉米夫定治疗持续时间较短是复发的重要危险因素。复发模式为ALT再次升高、HBV DNA再次出现（69例患者）和HBeAg再次出现（55例患者）。
为预防拉米夫定治疗后慢性乙型肝炎感染患者复发，应考虑患者的年龄和血清胆红素水平以及延长额外拉米夫定治疗的持续时间。
