核苷（酸）类似物治疗停止后 HBeAg 阴性慢性乙型肝炎患者复发的预测因素：一项荟萃分析。

Predictors of relapse after cessation of nucleos(t)ide analog treatment in HBeAg-negative chronic hepatitis B patients: A meta-analysis.

机构信息

Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180# Fenglin Road, Shanghai, People's Republic of China.

Department of Gastroenterology, Huadong Hospital, Fudan University, Shanghai, People's Republic of China.

出版信息

Int J Infect Dis. 2019 Sep;86:201-207. doi: 10.1016/j.ijid.2019.07.036. Epub 2019 Aug 5.

DOI:10.1016/j.ijid.2019.07.036

PMID:31394205

Abstract

OBJECTIVES

The aim of this study was to identify the predictors of relapse after the withdrawal of nucleos(t)ide analog (NA) therapy in patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB).

METHODS

The PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched through January 2019. A random-effects model meta-analysis was performed, with hazard ratios (HR) and 95% confidence intervals (CI) used as summary statistics.

RESULTS

Seventeen studies were included in the meta-analysis. Age (HR=1.022 per year), baseline hepatitis B surface antigen (HBsAg) (HR=1.509 per log IU/l), end of treatment (EOT) HBsAg level (HR=1.896 per log IU/l), EOT HBsAg level ≥1000 IU/ml (HR=1.749), and HBsAg decline from baseline to EOT (HR=0.748 per log IU/l) were associated with virological relapse. The predictors of clinical relapse were baseline HBsAg level (HR=1.312 per log IU/l), EOT HBsAg level (HR=1.458 per log IU/l), EOT HBsAg level ≥100IU/ml (HR=3.199) or ≥1000 IU/ml (HR=1.810), and duration of consolidation therapy (HR=0.991 per month).

CONCLUSIONS

This meta-analysis indicates that age, the duration of consolidation therapy, and levels of baseline and EOT HBsAg were factors predictive of relapse in HBeAg-negative CHB patients who discontinued NA treatment.

摘要

目的

本研究旨在确定乙型肝炎 e 抗原（HBeAg）阴性慢性乙型肝炎（CHB）患者停止核苷（酸）类似物（NA）治疗后复发的预测因素。

方法

检索 PubMed、EMBASE、Cochrane 中央对照试验注册库和 Web of Science 数据库，检索时间截至 2019 年 1 月。采用随机效应模型进行荟萃分析，使用风险比（HR）和 95%置信区间（CI）作为汇总统计量。

结果

荟萃分析纳入了 17 项研究。年龄（每年增加 1.022）、基线乙型肝炎表面抗原（HBsAg）（每 log IU/l 增加 1.509）、治疗结束时（EOT）HBsAg 水平（每 log IU/l 增加 1.896）、EOT HBsAg 水平≥1000IU/ml（HR=1.749）和从基线到 EOT 的 HBsAg 下降（每 log IU/l 减少 0.748）与病毒学复发相关。临床复发的预测因素是基线 HBsAg 水平（每 log IU/l 增加 1.312）、EOT HBsAg 水平（每 log IU/l 增加 1.458）、EOT HBsAg 水平≥100IU/ml（HR=3.199）或≥1000IU/ml（HR=1.810）和巩固治疗时间（每月减少 0.991）。