Association Between Level of Hepatitis B Surface Antigen and Relapse After Entecavir Therapy for Chronic Hepatitis B Virus Infection
Association Between Level of Hepatitis B Surface Antigen and Relapse After Entecavir Therapy for Chronic Hepatitis B Virus Infection
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DOI：
10.1016/j.cgh.2015.06.002
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发表时间：
2015-11-01
影响因子：
12.6
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;Hung, Chao-Hung;Lee, Chuan-Mo
背景与目的：我们调查了恩替卡韦治疗慢性B型肝炎后B型肝炎病毒（HBV）感染的复发率以及B型肝炎表面抗原（HBsAg）水平与复发的关系。在一项回顾性研究中，我们分析了252例慢性HBV感染患者的数据，这些患者接受恩替卡韦治疗，并符合亚太肝脏研究协会的治疗停止规则（平均时间，164 +/- 45周）。83例为B e抗原（HBeAg）阳性，169例为HBeAg阴性。患者接受至少12个月的定期治疗后随访检查。根据恩替卡韦治疗后血清HBV DNA >2000 IU/mL来定义病毒学复发。临床复发定义为丙氨酸氨基转移酶水平>2倍正常上限和HBV DNA >2000 IU/mL.Results：治疗结束后2年，42%的HBeAg阳性患者病毒学复发，37.6%的患者临床复发;治疗结束后3年，HBeAg阴性患者病毒学复发率分别为64.3%和51.6%。根据考克斯回归分析，与病毒学和临床复发独立相关的因素包括高龄、HBV C基因型和HBeAg阳性患者的较高基线HBsAg水平，以及高龄和HBeAg阴性患者的较高治疗结束时HBsAg水平。在HBeAg阳性患者中，HBV复发的风险随着年龄≥ 40岁和基线HBsAg水平≥ 1000 IU/mL而增加（P < .001）。在HBeAg阴性患者中，治疗结束时年龄（< 55岁）和HBsAg水平（< 150 IU/mL）的组合与较低的病毒学复发率相关（4.5%的HBeAg阴性患者在第3年发生病毒复发）。从12个月的治疗，直到治疗结束的HBsAg水平的下降是更大的恩替卡韦治疗后失去HBsAg的患者相比，那些谁没有。结论：年龄和HBsAg水平的结合与恩替卡韦治疗后HBV感染复发。HBsAg水平可用于指导慢性HBV感染患者停止恩替卡韦治疗的时间。
BACKGROUND & AIMS: We investigated the rate of relapse of hepatitis B virus (HBV) infection after entecavir therapy for chronic hepatitis B and the association between level of hepatitis B surface antigen (HBsAg) and relapse.METHODS: In a retrospective study, we analyzed data from 252 patients with chronic HBV infection who were treated with entecavir and met the Asian Pacific Association for the Study of the Liver treatment stopping rules (mean time, 164 +/- 45 weeks) from January 2007 through June 2011 in Taiwan. Eighty-three were hepatitis B e antigen (HBeAg)-positive, and 169 were HBeAg-negative. Patients had regular post-treatment follow-up examinations for at least 12 months. Virologic relapse was defined on the basis of serum HBV DNA >2000 IU/mL after entecavir therapy. Clinical relapse was defined as a level of alanine aminotransferase >2-fold the upper limit of normal and HBV DNA >2000 IU/mL.RESULTS: Two years after therapy ended, 42% of HBeAg-positive patients had a virologic relapse, and 37.6% had a clinical relapse; 3 years after therapy ended, these rates were 64.3% and 51.6% for HBeAg-negative patients, respectively. On the basis of Cox regression analysis, factors independently associated with virologic and clinical relapse included old age, HBV genotype C, and higher baseline levels of HBsAg for HBeAg-positive patients and old age and higher end-of-treatment levels of HBsAg for HBeAg-negative patients. In HBeAg-positive patients, risk of HBV relapse increased with age >= 40 years and HBsAg level >= 1000 IU/mL at baseline (P < .001). In HBeAg-negative patients, the combination of age (< 55 years) and HBsAg level (< 150 IU/mL) at the end of treatment was associated with a lower rate of virologic relapse (4.5% of HBeAg-negative patients had viral relapse at year 3). The decrease in level of HBsAg from month 12 of treatment until the end of treatment was greater in patients who did lose HBsAg after entecavir therapy compared with those who did not.CONCLUSIONS: The combination of age and level of HBsAg is associated with relapse of HBV infection after treatment with entecavir. HBsAg levels might be used to guide the timing of cessation of entecavir treatment in patients with chronic HBV infection.