未经治疗和接受核苷（酸）类似物治疗的患者中乙肝表面抗原血清清除的持久性。
Durability of hepatitis B surface antigen seroclearance in untreated and nucleos(t)ide analogue-treated patients.
作者信息
Yip Terry Cheuk-Fung, Wong Grace Lai-Hung, Wong Vincent Wai-Sun, Tse Yee-Kit, Lui Grace Chung-Yan, Lam Kelvin Long-Yan, Chan Henry Lik-Yuen
机构信息
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
出版信息
J Hepatol. 2017 Oct 6. doi: 10.1016/j.jhep.2017.09.018.
BACKGROUND & AIMS: It is uncertain if nucleos(t)ide analogue (NA)-induced hepatitis B surface antigen (HBsAg) seroclearance is durable. We investigated the impact of hepatitis B surface antibody (anti-HBs) and duration of consolidation antiviral therapy on the durability of HBsAg seroclearance.
METHODS
A territory-wide cohort study was conducted using data from the Hospital Authority, Hong Kong. We identified all subjects with positive HBsAg between January 1, 2000 and August 31, 2016. NA use, liver biochemistries, serial HBsAg and anti-HBs results were retrieved. The primary endpoint was confirmed HBsAg seroclearance, defined least two negative HBsAg test results, with the last HBsAg test being negative in patients with chronic hepatitis B (CHB).
RESULTS
A total of 4,080 CHB patients were included for analysis. In patients with spontaneous HBsAg seroclearance (n=3,563), 1,771 patients (49.7%) had confirmed HBsAg seroclearance and 75 patients (2.1%) had HBsAg seroreversion. In patients with NA-induced HBsAg seroclearance (n=475), 320 patients (67.4%) had confirmed HBsAg seroclearance and 14 patients (2.9%) had HBsAg seroreversion. The five-year cumulative probability of confirmed HBsAg seroclearance was comparable in patients with spontaneous and NA-induced HBsAg seroclearance (88.1% vs. 92.2%; Log-rank test, p=0.964); it was also similar in patients with or without anti-HBs in NA-treated patients (95.4% vs. 95.5%, Log-rank test, p=0.602). HBsAg seroreversion was only observed in 3 (2.0%) patients who had received consolidation therapy for 6-12months and none of those who had received it for ≥12months.
CONCLUSIONS
NA-induced HBsAg seroclearance is as durable as spontaneous HBsAg seroclearance. NA-treated patients may not need to have positive anti-HBs before stopping treatment. Longer consolidation NA treatment may result in more durable HBsAg seroclearance.
LAY SUMMARY
We investigated 4,080 patients with hepatitis B surface antigen (HBsAg) seroclearance. HBsAg seroreversion occurred in 2.1% of patients with spontaneous and 2.9% of those with nucleos(t)ide analogues-induced HBsAg seroclearance.
背景与目的
核苷（酸）类似物（NA）诱导的乙肝表面抗原（HBsAg）血清学清除是否持久尚不确定。我们研究了乙肝表面抗体（抗-HBs）和巩固抗病毒治疗持续时间对HBsAg血清学清除持久性的影响。
方法
利用香港医院管理局的数据进行了一项全地区队列研究。我们确定了2000年1月1日至2016年8月31日期间所有HBsAg阳性的受试者。检索了NA使用情况、肝脏生化指标、连续的HBsAg和抗-HBs结果。主要终点是确诊的HBsAg血清学清除，定义为至少两次HBsAg检测结果为阴性，慢性乙型肝炎（CHB）患者的最后一次HBsAg检测为阴性。
结果
共纳入4080例CHB患者进行分析。在自发HBsAg血清学清除的患者（n = 3563）中，1771例患者（49.7%）确诊HBsAg血清学清除，75例患者（2.1%）出现HBsAg血清学逆转。在NA诱导的HBsAg血清学清除的患者（n = 475）中，320例患者（67.4%）确诊HBsAg血清学清除，14例患者（2.9%）出现HBsAg血清学逆转。自发和NA诱导的HBsAg血清学清除患者确诊HBsAg血清学清除的五年累积概率相当（88.1%对92.2%；对数秩检验，p = 0.964）；在接受NA治疗的患者中，有或没有抗-HBs的患者情况也相似（95.4%对95.5%，对数秩检验，p = 0.602）。仅在3例（2.0%）接受了6 - 12个月巩固治疗的患者中观察到HBsAg血清学逆转，而接受≥12个月巩固治疗的患者中未观察到。
结论
NA诱导的HBsAg血清学清除与自发的HBsAg血清学清除一样持久。接受NA治疗的患者在停药前可能不需要抗-HBs呈阳性。更长时间的NA巩固治疗可能导致更持久的HBsAg血清学清除。
简要概述
我们研究了4080例乙肝表面抗原（HBsAg）血清学清除的患者。自发HBsAg血清学清除的患者中有2.1%出现HBsAg血清学逆转，核苷（酸）类似物诱导的HBsAg血清学清除的患者中有2.9%出现HBsAg血清学逆转。
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