Department of Medicine, Shinshu University School of Medicine, Matsumoto Department of Hepatology, Toranomon Hospital Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Tokyo Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences Gastroenterology Section, Nagoya Daini Red Cross Hospital, Nagoya Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University Department of Gastroenterology, Sapporo Kosei General Hospital, Sapporo The Clinical Research Center, NHO Nagasaki Medical Center, Omura Program for Biomedical Research, Division of Frontier Medical Science, Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba Division of Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo College of Medicine, Hyogo Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
Hepatol Res. 2012 Feb;42(2):139-49. doi: 10.1111/j.1872-034X.2011.00910.x. Epub 2011 Nov 22.
The factors associated with hepatitis recurrence after discontinuation of nucleos(t)ide analogs (NAs) in patients with chronic hepatitis B were analyzed to predict the risk of relapse more accurately.
A total of 126 patients who discontinued NA therapy were recruited retrospectively. The clinical conditions of a successful discontinuation were set as alanine aminotransferase (ALT) below 30 IU/L and serum hepatitis B virus (HBV) DNA below 4.0 log copies/mL.
Relapse of hepatitis B were judged to occur when maximal serum ALT became higher than 79 IU/L or when maximal serum HBV DNA surpassed 5.7 log copies/mL following NA discontinuation since these values corresponded with mean values of ALT (30 IU/L) and HBV DNA (4.0 log copies/mL), respectively. At least 90% of patients with either detectable hepatitis B e antigen or serum HBV DNA higher than 3.0 log copies/mL at the time of NA discontinuation relapsed within one year. In the remaining patients, higher levels of both hepatitis B surface and core-related antigens at the time of discontinuation, as well as a shorter course of NA treatment, were significantly associated with relapse by multivariate analysis.
It appears that negative results for hepatitis B e antigen and serum HBV DNA lower than 3.0 log copies/mL are essential for successful NA discontinuation, which may be attained by a longer treatment period. Levels of hepatitis B surface and core-related antigens are also significant factors independently associated with relapse of hepatitis.
分析核苷（酸）类似物（NAs）停药后慢性乙型肝炎患者肝炎复发的相关因素，以更准确地预测复发风险。
回顾性招募了 126 名成功停止 NAs 治疗的患者。成功停药的临床条件设定为丙氨酸氨基转移酶（ALT）低于 30IU/L 和血清乙型肝炎病毒（HBV）DNA 低于 4.0 log 拷贝/mL。
NA 停药后，当最大血清 ALT 高于 79IU/L 或最大血清 HBV DNA 超过 5.7 log 拷贝/mL 时，判断乙型肝炎复发，因为这些值分别对应于 ALT（30IU/L）和 HBV DNA（4.0 log 拷贝/mL）的平均值。至少 90%的患者在停止 NAs 治疗时检测到乙型肝炎 e 抗原或血清 HBV DNA 高于 3.0 log 拷贝/mL，一年内会复发。在其余患者中，停药时乙型肝炎表面和核心相关抗原水平较高，以及 NAs 治疗疗程较短，通过多变量分析与复发显著相关。
乙型肝炎 e 抗原阴性和血清 HBV DNA 低于 3.0 log 拷贝/mL 的结果似乎是成功停止 NAs 治疗的必要条件，这可能通过延长治疗时间来实现。乙型肝炎表面和核心相关抗原水平也是与肝炎复发独立相关的重要因素。
