Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
J Gastroenterol Hepatol. 2013 Dec;28(12):1849-58. doi: 10.1111/jgh.12283.
The role of serum hepatitis B surface antigen (HBsAg) level in determining virological breakthrough (VB) for patients with hepatitis B virus (HBV) infection receiving lamivudine remains unclear. The study aimed to evaluate the impact of serum HBsAg levels on VB among patients receiving lamivudine therapy, especially in a setting of low HBV viral load.
Two hundred sixty-eight consecutive treatment-naïve patients who underwent lamivudine therapy for chronic hepatitis B were enrolled. Factors in terms of VB were analyzed by multivariate analysis.
After a median treatment duration of 67.1 weeks, 102 patients had VB. Multivariate analysis showed that positive hepatitis B e antigen (HBeAg) (hazard ratio 2.165, P = 0.026) and HBV DNA levels ≥ 2000 IU/mL after 6 months of lamivudine therapy (hazard ratio 5.236, P = 0.001) were independent risk factors predicting VB. The cumulative VB rates stratified by HBeAg-positive and -negative at 3 years were 44.7% and 26.3%, respectively. At 3 years, the cumulative VB rates stratified by the HBV DNA < 2000 and ≥ 2000 IU/mL after 6 months of therapy were 25.5% and 79.4%, respectively. For HBeAg-positive patients with serum HBV DNA < 2000 IU/mL after 6 months of therapy, baseline HBsAg levels ≥ 20,000 IU/mL was the only risk factor associated with VB.
For chronic hepatitis B patients treated with lamivudine, serum HBV DNA level > 2000 IU/mL after 6 months of therapy could predict subsequent VB. In patients with lower on-treatment viral load, baseline serum HBsAg level is associated with the emergence of VB, especially for those with serum positive HBeAg.
血清乙型肝炎表面抗原（HBsAg）水平在决定接受拉米夫定治疗的乙型肝炎病毒（HBV）感染患者发生病毒学突破（VB）中的作用尚不清楚。本研究旨在评估血清 HBsAg 水平对接受拉米夫定治疗的患者发生 VB 的影响，尤其是在 HBV 病毒载量较低的情况下。
纳入 268 例接受拉米夫定治疗的初治慢性乙型肝炎患者。采用多因素分析方法分析 VB 的相关因素。
中位治疗时间为 67.1 周后，有 102 例患者发生 VB。多因素分析显示，乙肝 e 抗原（HBeAg）阳性（危险比 2.165，P=0.026）和拉米夫定治疗 6 个月后 HBV DNA 水平≥2000 IU/mL（危险比 5.236，P=0.001）是预测 VB 的独立危险因素。HBeAg 阳性和阴性患者在 3 年内的累积 VB 发生率分别为 44.7%和 26.3%。在治疗 6 个月后 HBV DNA <2000 和≥2000 IU/mL 的患者中，在 3 年内的累积 VB 发生率分别为 25.5%和 79.4%。对于 HBeAg 阳性且治疗 6 个月后血清 HBV DNA <2000 IU/mL 的患者，基线 HBsAg 水平≥20000 IU/mL 是与 VB 相关的唯一危险因素。
对于接受拉米夫定治疗的慢性乙型肝炎患者，治疗 6 个月后血清 HBV DNA 水平>2000 IU/mL 可预测随后发生 VB。在病毒载量较低的患者中，基线血清 HBsAg 水平与 VB 的发生相关，尤其是血清 HBeAg 阳性的患者。
