乙型肝炎 e 抗原阴性慢性乙型肝炎患者接受核苷（酸）类似物治疗期间乙型肝炎表面抗原动力学。
Hepatitis B s antigen kinetics during treatment with nucleos(t)ides analogues in patients with hepatitis B e antigen-negative chronic hepatitis B.
机构信息
2nd Department of Internal Medicine, Hippokration General Hospital of Athens, Medical School of National & Kapodistrian University of Athens, Athens, Greece.
Department of Gastroenterology, Laiko General Hospital of Athens, Medical School of National & Kapodistrian University of Athens, Athens, Greece.
出版信息
Liver Int. 2017 Nov;37(11):1642-1650. doi: 10.1111/liv.13432. Epub 2017 Apr 26.
BACKGROUND/AIMS: Serum hepatitis B s antigen (HBsAg) levels might be used as a predictor of virological breakthrough or of sustained off-treatment virological response in hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) patients. We evaluated the changes of HBsAg in those patients under nucleos(t)ide analogue(s) [NA(s)] therapy for ≥12 months.
METHODS
We included 99 HBeAg-negative CHB patients treated with low-genetic barrier NA(s) for a mean of 66 months (lamivudine: 66, adefovir: 6, lamivudine plus adefovir: 11 and telbivudine: 16) and 86 HBeAg-negative CHB patients treated under entecavir or tenofovir for a mean of 30 months as the comparison group.
RESULTS
Compared to baseline, HBsAg levels decreased by a median of 162, 1525, 943, 1545, 2163 and 3859 IU/mL at 6, 12, 24, 36, 48 and 60 months of therapy with low-genetic barrier NA(s) respectively. The 6-, 12-, 24-, 36-, 48- and 60-month cumulative rates of HBsAg<100 IU/mL were 2%, 3%, 3%, 5%, 5% and 5%, and <1000 IU/mL 6%, 9%, 15%, 19%, 24% and 61% respectively. Baseline HBsAg levels were the only significant variable associated with the time to HBsAg drop <1000 IU/mL. HBsAg loss occurred in 3.0% of patients. The high-genetic barrier NAs were not found to offer a greater or faster HBsAg decline.
CONCLUSIONS
In HBeAg-negative CHB patients, long-term therapy with low-genetic barrier NA(s) decreases serum HBsAg levels, but the rate of decline is slow. Lower baseline HBsAg levels are significantly associated with on-therapy HBsAg drop <1000 IU/mL. Serum HBsAg decline is similar during therapy with low- or high-genetic barrier NAs.
背景/目的：血清乙型肝炎表面抗原（HBsAg）水平可用于预测乙型肝炎 e 抗原（HBeAg）阴性慢性乙型肝炎（CHB）患者治疗中病毒学突破或停药后持续病毒学应答。我们评估了在接受核苷（酸）类似物（NA）治疗≥12 个月的这些患者中 HBsAg 的变化。
方法
我们纳入了 99 例接受低遗传屏障 NA 治疗平均 66 个月（拉米夫定：66 例，阿德福韦：6 例，拉米夫定加阿德福韦：11 例，替比夫定：16 例）和 86 例接受恩替卡韦或替诺福韦治疗平均 30 个月的 HBeAg 阴性 CHB 患者作为对照组。
结果
与基线相比，低遗传屏障 NA 治疗 6、12、24、36、48 和 60 个月时 HBsAg 水平中位数分别下降 162、1525、943、1545、2163 和 3859 IU/ml。6、12、24、36、48 和 60 个月时 HBsAg<100 IU/ml 的累积率分别为 2%、3%、3%、5%、5%和 5%，HBsAg<1000 IU/ml 的累积率分别为 6%、9%、15%、19%、24%和 61%。基线 HBsAg 水平是与 HBsAg 下降至<1000 IU/ml 时间相关的唯一显著变量。有 3.0%的患者发生 HBsAg 丢失。高遗传屏障 NA 并未显示出更大或更快的 HBsAg 下降。
结论
在 HBeAg 阴性 CHB 患者中，长期接受低遗传屏障 NA 治疗可降低血清 HBsAg 水平，但下降速度较慢。较低的基线 HBsAg 水平与治疗期间 HBsAg 下降至<1000 IU/ml 显著相关。低遗传屏障与高遗传屏障 NA 治疗期间 HBsAg 下降相似。
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