Department of Infectious Disease, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215006, Jiangsu Province, China; The Wuxi Fifth Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, China.
The Wuxi Fifth Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, China.
Int J Infect Dis. 2016 Feb;43:43-48. doi: 10.1016/j.ijid.2015.10.019. Epub 2015 Oct 30.
To assess off-treatment virological relapse rates and to determine the role of hepatitis B surface antigen (HBsAg) quantification in predicting virological relapse after stopping entecavir (ETV) treatment in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB).
One hundred and twelve CHB patients for whom ETV was stopped in accordance with the Asian Pacific Association for the Study of the Liver guidelines stopping rules were enrolled. Patient HBsAg and HBV DNA levels were monitored every 4-12 weeks during ETV treatment and after ETV cessation. Post-treatment virological relapse was defined as a serum HBV DNA level of >10 000 copies/ml after stopping ETV treatment.
The virological relapse rate at 52 weeks after stopping ETV was 48.2%. The post-treatment virological relapse rate was significantly higher in patients aged >50 years than in those aged <50 years (p < 0.001), and the virological relapse rate was significantly lower in patients with an HBsAg level <2.0 log10 IU /ml than in those with a level ≥ 2.0 log10 IU /ml at ETV cessation (p = 0.005). An HBsAg level of 2.5 log10 IU/ml at HBeAg seroconversion was the optimal cut-off value for predicting post-treatment virological relapse (p < 0.001). In those aged <50 years and with HBsAg ≤ 2.5 log10 IU/ml at HBeAg seroconversion, the relapse rate was only 5%. In patients with HBsAg ≤ 2.5 log10 IU/ml at HBeAg seroconversion, 52.4% achieved HBsAg levels ≤ 2.0 log10 IU/ml at ETV cessation, while in those with HBsAg >2.5 log10 IU/ml at HBeAg seroconversion, only 4.4% achieved this criterion.
HBsAg levels can help guide the timing of cessation of ETV treatment. HBsAg levels of 2.5 log10 IU/ml at HBeAg seroconversion may be a useful marker to predict virological relapse after the cessation of ETV treatment in HBeAg-positive CHB patients.
评估停药后病毒学复发率，并确定乙型肝炎表面抗原 (HBsAg) 定量在预测乙型肝炎 e 抗原 (HBeAg) 阳性慢性乙型肝炎 (CHB) 患者停止恩替卡韦 (ETV) 治疗后病毒学复发中的作用。
按照亚太肝病学会停药标准，纳入 112 例符合 ETV 停药条件的 CHB 患者。在 ETV 治疗期间和停药后，每 4-12 周监测患者 HBsAg 和 HBV DNA 水平。停药后病毒学复发定义为停止 ETV 治疗后血清 HBV DNA 水平>10000 拷贝/ml。
停药后 52 周的病毒学复发率为 48.2%。年龄>50 岁的患者病毒学复发率明显高于年龄<50 岁的患者 (p<0.001)，停药时 HBsAg 水平<2.0 log10 IU/ml 的患者病毒学复发率明显低于水平≥2.0 log10 IU/ml 的患者 (p=0.005)。HBeAg 血清学转换时 HBsAg 水平为 2.5 log10 IU/ml 是预测停药后病毒学复发的最佳截断值 (p<0.001)。在年龄<50 岁且 HBeAg 血清学转换时 HBsAg≤2.5 log10 IU/ml 的患者中，复发率仅为 5%。在 HBeAg 血清学转换时 HBsAg≤2.5 log10 IU/ml 的患者中，52.4%的患者在 ETV 停药时 HBsAg 水平≤2.0 log10 IU/ml，而在 HBeAg 血清学转换时 HBsAg>2.5 log10 IU/ml 的患者中，只有 4.4%达到这一标准。
HBsAg 水平有助于指导 ETV 治疗停药的时机。HBeAg 阳性 CHB 患者 HBeAg 血清学转换时 HBsAg 水平为 2.5 log10 IU/ml 可能是预测 ETV 停药后病毒学复发的有用标志物。
