Du Jeong In, Jung Seok Won, Park Bo Ryung, Lee Byung Uk, Park Jae Ho, Kim Byung Gyu, Bang Sung-Jo, Shin Jung Woo, Park Neung Hwa
Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 887 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
Biomedical Research Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
Dig Dis Sci. 2017 Oct;62(10):2908-2914. doi: 10.1007/s10620-017-4737-1. Epub 2017 Sep 4.
BACKGROUND/AIMS: The clinical course of chronic hepatitis B (CHB) patients with partial virologic response (PVR) during tenofovir disoproxil fumarate (TDF) therapy remains unclear.
We retrospectively investigated the long-term clinical outcomes of TDF treatment in nucleos(t)ides-naïve CHB patients, particularly in those with PVR.
A total of 391 patients treated with TDF therapy for more than 12 months were included. Virologic response (VR) was achieved in 341 patients (87.2%). PVR was evident in 127 (45.3%) of the 391 patients. Multivariate logistic regression analysis using selected baseline factors identified absolute HBV DNA levels at baseline (OR 0.496; 95% CI 1.369-1.969) and HBeAg positivity (OR 0.622; 95% CI 1.096-3.167) as factors significantly associated with PVR. During continuous prolonged TDF therapy, 127 (71.8%) of 177 patients with PVR achieved VR. The cumulative rates of VR in patients with PVR at 12, 24, and 36 months were 42.4, 79.7, and 90.2%, respectively. Serum HBV DNA level at week 24 was significantly associated with VR in patients with PVR.
The vast majority of CHB patients with PVR achieved VR through prolonged TDF therapy, although the time to achieve VR was delayed in those with PVR. This suggests that adjustment of TDF therapy in patients with PVR is unnecessary.
背景/目的：富马酸替诺福韦二吡呋酯（TDF）治疗期间出现部分病毒学应答（PVR）的慢性乙型肝炎（CHB）患者的临床病程仍不明确。
我们回顾性研究了初治CHB患者TDF治疗的长期临床结局，尤其是那些出现PVR的患者。
共纳入391例接受TDF治疗超过12个月的患者。341例患者（87.2%）实现了病毒学应答（VR）。391例患者中有127例（45.3%）出现明显的PVR。使用选定的基线因素进行多因素逻辑回归分析确定基线时的绝对HBV DNA水平（OR 0.496；95%CI 1.369 - 1.969）和HBeAg阳性（OR 0.622；95%CI 1.096 - 3.167）为与PVR显著相关的因素。在持续延长TDF治疗期间，177例出现PVR的患者中有127例（71.8%）实现了VR。出现PVR的患者在12、24和36个月时的VR累积率分别为42.4%、79.7%和90.2%。第24周时的血清HBV DNA水平与出现PVR的患者的VR显著相关。
绝大多数出现PVR的CHB患者通过延长TDF治疗实现了VR，尽管出现PVR的患者实现VR的时间有所延迟。这表明对出现PVR的患者调整TDF治疗没有必要。
