Kim Ji Hoon, Lee Sun Jae, Joo Moon Kyung, Kim Chung Ho, Choi Jong Hwan, Jung Young Kul, Yim Hyung Joon, Yeon Jong Eun, Park Jong-Jae, Kim Jae Seon, Bak Young Tae, Byun Kwan Soo
Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, 97, Guro-Dong Gil, Guro-Dong, Guro-Ku, Seoul, 152-703, South Korea.
Dig Dis Sci. 2009 Jul;54(7):1572-7. doi: 10.1007/s10620-008-0508-3. Epub 2008 Oct 31.
The purpose of this study is to determine the long-term relapse rate and associated risk factors in HBeAg-positive chronic hepatitis B (CHB) patients who had maintained virologic response (VR) for 1 year after lamivudine (LMV) discontinuation. We enrolled 55 treatment-naive HBeAg-positive CHB patients who achieved and maintained VR until 1 year after LMV discontinuation. Delayed relapse was defined as an elevation of HBV DNA after sustained VR for 1 year. During follow-up, 16 of 55 patients (29%) showed delayed relapse. Beginning 1 year after LMV discontinuation, the cumulative rates of relapse after 2 and 4 years were 29 and 44%, respectively. In multivariate analysis, age (P = 0.029) and >2,000 copies/ml HBV DNA 3 months after LMV discontinuation (P = 0.047) were significant predictors of delayed relapse. Delayed relapse is not infrequent, even in patients who maintain VR for 1 year after LMV discontinuation. Therefore, LMV maintenance therapy might be considered in HBeAg-positive CHB patients who achieve VR.
本研究的目的是确定在停用拉米夫定（LMV）后实现病毒学应答（VR）达1年的HBeAg阳性慢性乙型肝炎（CHB）患者的长期复发率及相关危险因素。我们纳入了55例初治的HBeAg阳性CHB患者，这些患者在停用LMV后实现并维持VR达1年。延迟复发定义为在持续VR达1年后HBV DNA升高。在随访期间，55例患者中有16例（29%）出现延迟复发。从停用LMV 1年后开始，2年和4年后的累积复发率分别为29%和44%。多因素分析显示，年龄（P = 0.029）和停用LMV 3个月后HBV DNA>2000拷贝/ml（P = 0.047）是延迟复发的显著预测因素。即使在停用LMV后维持VR达1年的患者中，延迟复发也并不罕见。因此，对于实现VR的HBeAg阳性CHB患者，可考虑采用LMV维持治疗。
