Young Chronic Hepatitis B Patients With Nucleos(t)ide Analogue-induced Hepatitis B e Antigen Seroconversion Have a Higher Risk of HBV Reactivation
Young Chronic Hepatitis B Patients With Nucleos(t)ide Analogue-induced Hepatitis B e Antigen Seroconversion Have a Higher Risk of HBV Reactivation
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DOI：
10.1093/infdis/jis569
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发表时间：
2012-11-15
影响因子：
6.4
通讯作者：
Kao, Jia-Horng
中科院分区：
文献类型：
--
作者：
Tseng, Tai-Chung;Liu, Chun-Jen;Kao, Jia-Horng
背景目前尚不清楚核苷（酸）类似物（NUC）诱导的B e抗原（HBeAg）血清转换是否具有与自发性HBeAg血清转换相似的预后。共148名非乙型肝炎病毒核酸诱导的HBeAg血清转换者连续入组。还招募了407例非乙型肝炎自发性HBeAg血清转换者的历史对照。我们比较了这两个队列之间HBeAg血清逆转率和HBV再激活率。自发性和NUC诱导的HBeAg血清转换分别有1652.8和465.2人-年的随访。与NUC诱导的血清转换相比，自发性血清转换者在实现HBeAg血清转换时更年轻。因此，我们根据HBeAg血清转换时的年龄比较了这2个队列。在30岁以前达到HBeAg血清转换的患者中，NUC诱导的血清转换比自发血清转换有更高的2年HBeAg血清转换率（12.0% vs 2.9%; P = 0.004），并且HBV再激活的风险更高（风险比，4.6; 95%置信区间，1.5-14.4）。多因素分析显示，在年轻HBeAg血清转换者中，NUC诱导的HBeAg血清转换仍然是两个终点的危险因素。NUC诱导的HBeAg血清转换在停止治疗后可能没有持久的应答。对于在30岁之前实现HBeAg血清转换的患者，在NUC诱导的血清转换中HBeAg血清转换和HBV再激活的风险高于自发性HBeAg血清转换。
Background. It is unclear whether hepatitis B e antigen (HBeAg) seroconversion induced by nucleos(t)ide analogues (NUC) has a prognosis that is similar to that of spontaneous HBeAg seroconversion.Methods. A total of 148 noncirrhotic NUC-induced HBeAg seroconverters were consecutively enrolled. A historical control of 407 noncirrhotic spontaneous HBeAg seroconverters was also recruited. We compared the rates of HBeAg seroreversion and HBV reactivation between these 2 cohorts.Results. There were 1652.8 and 465.2 person-years of follow-up for spontaneous and NUC-induced HBeAg seroconverters, respectively. Compared with NUC-induced seroconverters, spontaneous seroconverters were younger when achieving HBeAg seroconversion. We thus compared these 2 cohorts according to their age at HBeAg seroconversion. In patients achieving HBeAg seroconversion before 30 years of age, NUC-induced seroconverters had a higher 2-year HBeAg seroreversion rate than spontaneous seroconverters (12.0% vs 2.9%; P = .004) and were at a higher risk of HBV reactivation (hazard ratio, 4.6; 95% confidence interval, 1.5-14.4). Using multivariate analysis, NUC-induced HBeAg seroconversion remained a risk factor of both endpoints in young HBeAg seroconverters.Conclusion. NUC-induced HBeAg seroconverters may not have durable response after stopping therapy. For patients achieving HBeAg seroconversion before 30 years of age, the risk of HBeAg seroreversion and HBV reactivation is higher in NUC-induced seroconverters than spontaneous HBeAg seroconverters.