治疗后 HBsAg 下降预示着在未进行补救治疗的 HBeAg 阴性患者中停止使用恩替卡韦或替诺福韦后 HBsAg 丢失率较高。

Post-treatment HBsAg decline predicts high rate of HBsAg loss after stopping entecavir or tenofovir in HBeAg-negative patients without retreatment.

机构信息

Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Kaohsiung, Taiwan, ROC.

出版信息

Dig Liver Dis. 2023 Sep;55(9):1223-1229. doi: 10.1016/j.dld.2023.02.006. Epub 2023 Mar 2.

DOI:10.1016/j.dld.2023.02.006

PMID:36870864

Abstract

BACKGROUND/AIMS: Little is known about the role of post-treatment HBsAg decline in HBsAg loss following nucleos(t)ide analogues cessation.

METHODS

HBeAg-negative patients without cirrhosis who previously received entecavir or tenofovir disoproxil fumarate (TDF) were enrolled (n=530). All patients were followed-up post-treatment for >24 months.

RESULTS

Of the 530 patients, 126 achieved sustained response (Group I), 85 experienced virological relapse without clinical relapse and retreatment (Group II), 67 suffered clinical relapse without retreatment (Group III) and 252 received retreatment (Group IV). The cumulative incidence of HBsAg loss at 8 years was 57.3% in Group I, 24.1% in Group II, 35.9% in Group III and 7.3% in Group IV. Cox regression analysis showed that nucleos(t)ide analogue experience, lower HBsAg levels at end-of-treatment (EOT) and higher HBsAg decline at 6 months after EOT were independently associated with HBsAg loss in Group I and Groups II+III. The rates of HBsAg loss at 6 years in patients with HBsAg decline >0.2 log IU/mL in Group I and HBsAg decline >0.15 log IU/mL in Group II+III at 6 months after EOT were 87.7% and 47.1%, respectively.

CONCLUSION

The HBsAg loss rate was high and post-treatment HBsAg decline could predict high HBsAg loss rate among HBeAg-negative patients who discontinued entecavir or TDF and did not need retreatment.

摘要

背景/目的：核苷（酸）类似物停药后 HBsAg 丢失与治疗后 HBsAg 下降的关系知之甚少。

方法

本研究纳入了先前接受恩替卡韦或替诺福韦酯（TDF）治疗的无肝硬化的 HBeAg 阴性患者（n=530）。所有患者在治疗后均随访>24 个月。

结果

530 例患者中，126 例获得持续应答（I 组），85 例发生无临床复发和再治疗的病毒学复发（II 组），67 例发生无再治疗的临床复发（III 组），252 例接受再治疗（IV 组）。I 组、II 组+III 组在 8 年内 HBsAg 丢失的累积发生率分别为 57.3%、24.1%、35.9%和 7.3%。Cox 回归分析显示，核苷（酸）类似物治疗史、治疗结束时 HBsAg 水平较低和治疗结束后 6 个月 HBsAg 下降较高与 I 组和 II 组+III 组的 HBsAg 丢失独立相关。在 I 组中，治疗结束后 6 个月 HBsAg 下降>0.2 log IU/mL 的患者和在 II 组+III 组中 HBsAg 下降>0.15 log IU/mL 的患者在 6 年内 HBsAg 丢失率分别为 87.7%和 47.1%。