Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J Hepatol. 2014 Sep;61(3):515-22. doi: 10.1016/j.jhep.2014.04.029. Epub 2014 May 2.
BACKGROUND & AIMS: We investigated whether the quantification of hepatitis surface antigen (HBsAg) could predict HBsAg loss or hepatitis B virus (HBV) relapse after stopping lamivudine treatment.
A total of 188 naive chronic hepatitis B patients (83 HBeAg-positive, 105 HBeAg-negative patients), who were previously treated with lamivudine (treatment duration: 89.3 ± 35.9 weeks, range: 52-243 weeks) but stopped the treatment for at least 12 months were recruited.
The cumulative incidence of HBsAg loss and HBV relapse at year 6 after stopping lamivudine treatment was 24% and 65.9% respectively. Cox regression analysis revealed that lower alanine aminotransferase (ALT) at baseline, lower HBsAg levels at the end of treatment, and longer treatment duration were independent predictors for HBsAg loss, and old age, male sex and higher HBsAg levels at the end of treatment were independent predictors for post-treatment HBV relapse. At the end of treatment, the HBsAg cut-off value of 300 IU/ml could predict 55.6% (5/9) HBsAg loss in HBeAg-positive patients. In HBeAg-negative patients, the HBsAg cut-off values of 120 and 200 IU/ml could predict 79.2% (19/24) HBsAg loss and 93.3% (28/30) post-treatment sustained response respectively. Further HBsAg reduction (>0.22 log IU/ml) at month 6 after stopping treatment was an independent predictor for HBsAg loss after adjusting for HBsAg level at the end of treatment.
Serum HBsAg level at the end of treatment is a useful predictor to guide the timing of stopping lamivudine treatment in chronic hepatitis B patients.
本研究旨在探讨乙型肝炎表面抗原（HBsAg）定量能否预测停止拉米夫定治疗后 HBsAg 消失或乙型肝炎病毒（HBV）复发。
共纳入 188 例初治慢性乙型肝炎患者（83 例 HBeAg 阳性，105 例 HBeAg 阴性），这些患者之前接受拉米夫定治疗（治疗时间：89.3±35.9 周，范围：52-243 周），且停药至少 12 个月。
停药后 6 年时 HBsAg 消失和 HBV 复发的累积发生率分别为 24%和 65.9%。Cox 回归分析显示，基线时较低的丙氨酸氨基转移酶（ALT）水平、治疗结束时较低的 HBsAg 水平和较长的治疗时间是 HBsAg 消失的独立预测因素，而年龄较大、男性和治疗结束时较高的 HBsAg 水平是 HBV 复发的独立预测因素。治疗结束时，HBsAg 临界值为 300IU/ml 可预测 55.6%（9/16）的 HBeAg 阳性患者 HBsAg 消失。在 HBeAg 阴性患者中，HBsAg 临界值分别为 120IU/ml 和 200IU/ml 可预测 79.2%（19/24）的 HBsAg 消失和 93.3%（28/30）的治疗后持续应答。停药后 6 个月 HBsAg 进一步降低（>0.22logIU/ml）是调整治疗结束时 HBsAg 水平后 HBsAg 消失的独立预测因素。
治疗结束时血清 HBsAg 水平是指导慢性乙型肝炎患者拉米夫定停药时机的有用预测指标。
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