Measurement of hepatitis B virus core-related antigen as predicting factor for relapse after cessation of lamivudine therapy for chronic hepatitis B virus infection
Measurement of hepatitis B virus core-related antigen as predicting factor for relapse after cessation of lamivudine therapy for chronic hepatitis B virus infection
复制标题
DOI：
10.1016/j.hepres.2006.08.005
复制
发表时间：
2006-12-01
影响因子：
4.2
通讯作者：
Mizokamia, Masashi
中科院分区：
文献类型：
--
作者：
Shinkai, Noboru;Tanaka, Yasuhiro;Mizokamia, Masashi
背景：拉米夫定长期治疗存在两个主要问题：治疗期间出现突破性肝炎以及治疗停止后转氨酶（ALT）复发。本研究的目的是检验可预测拉米夫定治疗停止后ALT急剧升高的因素。
方法：我们分析了22例日本慢性乙型肝炎感染患者，这些患者在连续至少6个月乙肝病毒（HBV）DNA水平检测不到（<3.7 LGE/ml）后停止拉米夫定治疗。治疗后随访中位数为28个月（范围9 - 41个月）。采用新开发的检测方法评估乙肝核心相关抗原（HBcrAg）。
结果：拉米夫定治疗停止后，11例患者（50%）复发（血清ALT重新激活>80 IU/L，复发者），其余11例（50%）未复发（未复发者）。在复发者与未复发者的单变量比较中，拉米夫定停药时的HBcrAg水平（4.5 ± 1.0对3.4 ± 0.9；p = 0.0145）已被证明是不复发的一个显著预测因素。所有在停药时HBcrAg <3.0 log U/ml的患者均无ALT急剧升高。对10个因素（年龄、性别、肝硬化、治疗前ALT水平、HBV DNA水平、HBcrAg水平、HBV DNA检测不到的平均月数、HBV DNA检测不到的持续时间以及拉米夫定停药时的HBcrAg水平）影响的多变量分析表明，拉米夫定停药时HBcrAg水平<3.4 log U/ml是治疗后不复发的唯一独立预测因素。
结论：拉米夫定停药时的HBcrAg水平可能作为拉米夫定治疗停止后反应的预后预测指标有用。HBcrAg的检测是监测慢性HBV感染的一种有用的补充检测方法。（c）2006爱思唯尔爱尔兰有限公司。保留所有权利。
Background: Prolonged lamivudine therapy has two major problems: breakthrough hepatitis during treatment and relapse of aminotransferase (ALT) after cessation of the therapy. The aim of this study was to examine factors that could predict ALT flare after stopping lamivudine therapy.Methods: We analyzed 22 Japanese patients with chronic hepatitis B infection, in whom lamivudine therapy was stopped after HBV DNA level had been gone undetectable (< 3.7 LGE/ml) during at least six consecutive months. The post-treatment followed up was carried for 28 months in median ( range 9 - 41). HBV core-related antigen ( HBcrAg) assay was assessed using newly developed assay.Results: After cessation of lamivudine therapy, 11 patients (50%) had relapsed ( reactivation of serum ALT > 80 IU/l, relapsers) and remaining 11 ( 50%) did not relapse (non-relapsers). In the univariate comparison of relapsers versus non-relapsers, HBcrAg level at lamivudine cessation point (4.5 +/- 1.0 versus 3.4 +/- 0.9; p = 0.0145) has been shown as a significant predictive factor for non-relapse. All patients with HBcrAg < 3.0 log U/ml at the cessation point had no ALT flares. Multivariate analysis on effects of 10 factors ( age, sex, cirrhosis, pretreatment ALT level, HBV DNA level, HBcrAg level, mean months till undetectable HBV DNA, duration of undetectable HBV DNA and HBcrAg level at lamivudine cessation point), indicated that HBcrAg level at lamivudine cessation point < 3.4 log U/ml was the only independent predictive factor for absence of the post-treatment relapse.Conclusions: HBcrAg level at lamivudine cessation point might be useful as a prognostic predictor of response to lamivudine therapy cessation. The measurement of HBcrAg is a useful additional test for monitoring chronic HBV infection. (c) 2006 Elsevier Ireland Ltd. All rights reserved.