The role of hepatitis B surface antigen quantification in predicting HBsAg loss and HBV relapse after discontinuation of lamivudine treatment
The role of hepatitis B surface antigen quantification in predicting HBsAg loss and HBV relapse after discontinuation of lamivudine treatment
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DOI：
10.1016/j.jhep.2014.04.029
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发表时间：
2014-09-01
影响因子：
25.7
通讯作者：
Lee, Chuan-Mo
中科院分区：
文献类型：
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作者：
Chen, Chien-Hung;Lu, Sheng-Nan;Lee, Chuan-Mo
背景和目标：我们研究了在停止拉米夫定治疗后，定量检测乙肝表面抗原（HBsAg）是否可以预测HBsAg丢失或B病毒（HBV）复发。（83例HBeAg阳性，105例HBeAg阴性），既往接受过拉米夫定治疗结果：拉米夫定停药后6年HBsAg丢失率为24%，HBV复发率为65.9%。考克斯回归分析显示，基线时较低的丙氨酸氨基转移酶（ALT）、治疗结束时较低的HBsAg水平和较长的治疗持续时间是HBsAg丢失的独立预测因素，老年、男性和治疗结束时较高的HBsAg水平是治疗后HBV复发的独立预测因素。治疗结束时，HBsAg临界值300 IU/ml可预测HBeAg阳性患者中55.6%（5/9）的HBsAg丢失。在HBeAg阴性的患者中，HBsAg临界值120和200 IU/ml分别可预测79.2%（19/24）的HBsAg丢失和93.3%（28/30）的治疗后持续应答。在调整治疗结束时的HBsAg水平后，在停止治疗后6个月HBsAg进一步降低（>0.22 log IU/ml）是HBsAg丢失的独立预测因子。结论：治疗结束时的血清HBsAg水平是指导慢性B型肝炎患者停止拉米夫定治疗时间的有用预测因子。(C)2014年欧洲肝脏研究协会。由Elsevier B出版。V.保留所有权利。
Background & Aims: We investigated whether the quantification of hepatitis surface antigen (HBsAg) could predict HBsAg loss or hepatitis B virus (HBV) relapse after stopping lamivudine treatment.Methods: A total of 188 naive chronic hepatitis B patients (83 HBeAg-positive, 105 HBeAg-negative patients), who were previously treated with lamivudine (treatment duration: 89.3 +/- 35.9 weeks, range: 52-243 weeks) but stopped the treatment for at least 12 months were recruited.Results: The cumulative incidence of HBsAg loss and HBV relapse at year 6 after stopping lamivudine treatment was 24% and 65.9% respectively. Cox regression analysis revealed that lower alanine aminotransferase (ALT) at baseline, lower HBsAg levels at the end of treatment, and longer treatment duration were independent predictors for HBsAg loss, and old age, male sex and higher HBsAg levels at the end of treatment were independent predictors for post-treatment HBV relapse. At the end of treatment, the HBsAg cut-off value of 300 IU/ml could predict 55.6% (5/9) HBsAg loss in HBeAg-positive patients. In HBeAg-negative patients, the HBsAg cut-off values of 120 and 200 IU/ml could predict 79.2% (19/24) HBsAg loss and 93.3% (28/30) post-treatment sustained response respectively. Further HBsAg reduction (>0.22 log IU/ml) at month 6 after stopping treatment was an independent predictor for HBsAg loss after adjusting for HBsAg level at the end of treatment.Conclusions: Serum HBsAg level at the end of treatment is a useful predictor to guide the timing of stopping lamivudine treatment in chronic hepatitis B patients. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B. V. All rights reserved.