Lai Chia-Yeh, Yang Sheng-Shun, Lee Shou-Wu, Tsai Hsin-Ju, Lee Teng-Yu
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
J Clin Med. 2021 Oct 23;10(21):4883. doi: 10.3390/jcm10214883.
Chronic hepatitis B (CHB) with severe acute exacerbation (SAE) is an urgent problem requiring nucleos(t)ide analogue (NA) therapy. We aim to evaluate the clinical relapse (CR) risk after discontinuing NA in patients with prior SAE.
In this retrospective cohort study, CHB patients who discontinued NA therapy were screened between October, 2003 and January, 2019. A total of 78 non-cirrhotic patients who had received NA therapy for CHB with SAE, i.e., bilirubin ≥ 2 mg/dL and/or prothrombin time prolongation ≥3 s, (SAE group) were matched 1:2 with 156 controls without SAE (non-SAE group) by means of propensity scores (age, gender, NA categories, NA therapy duration, and HBeAg status).
The 5-year cumulative incidences of severe CR, i.e., ALT > 10X ULN, (42.78%, 95% CI: 27.84-57.73% vs. 25.42%, 95% CI: 16.26-34.58%; = 0.045) and SAE recurrence (25.91%, 95% CI: 10.91-40.91% vs. 1.04%, 95% CI: 0-3.07%; < 0.001) were significantly higher in the SAE group. Prior SAE history (HR 1.79, 95% CI: 1.04-3.06) was an independent factor for severe CR. The 5-year cumulative incidence of HBsAg seroclearance was significantly higher in the SAE group than that in the non-SAE group (16.82%, 95% CI: 2.34-31.30% vs. 6.02%, 95% CI: 0-13.23%; = 0.049).
Even though it creates a greater chance of HBsAg seroclearance, NA therapy cessation may result in a high risk of severe CR in non-cirrhotic CHB patients with prior SAE.
伴有严重急性加重（SAE）的慢性乙型肝炎（CHB）是一个需要核苷（酸）类似物（NA）治疗的紧迫问题。我们旨在评估既往有SAE的患者停用NA后的临床复发（CR）风险。
在这项回顾性队列研究中，对2003年10月至2019年1月期间停用NA治疗的CHB患者进行筛选。共有78例非肝硬化患者因CHB伴SAE接受了NA治疗，即胆红素≥2mg/dL和/或凝血酶原时间延长≥3s（SAE组），通过倾向评分（年龄、性别、NA类别、NA治疗持续时间和HBeAg状态）以1:2的比例与156例无SAE的对照者（非SAE组）进行匹配。
严重CR（即ALT>10倍ULN）的5年累积发生率在SAE组显著更高（42.78%，95%CI：27.84 - 57.73%对25.42%，95%CI：16.26 - 34.58%；P = 0.045），SAE复发的5年累积发生率也是如此（25.91%，95%CI：10.91 - 40.91%对1.04%，95%CI：0 - 3.07%；P < 0.001）。既往SAE病史（HR 1.79，95%CI：1.04 - 3.06）是严重CR的独立因素。SAE组HBsAg血清学清除的5年累积发生率显著高于非SAE组（16.82%，95%CI：2.34 - 31.30%对6.02%，95%CI：0 - 13.23%；P = 0.049）。
尽管NA治疗停药可能会增加HBsAg血清学清除的机会，但对于既往有SAE的非肝硬化CHB患者，可能会导致严重CR的高风险。
