Durability of hepatitis B surface antigen seroclearance in untreated and nucleos(t)ide analogue-treated patients
Durability of hepatitis B surface antigen seroclearance in untreated and nucleos(t)ide analogue-treated patients
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DOI：
10.1016/j.jhep.2017.09.018
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发表时间：
2018-01-01
影响因子：
25.7
通讯作者：
Chan, Henry Lik-Yuen
中科院分区：
文献类型：
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作者：
Yip, Terry Cheuk-Fung;Wong, Grace Lai-Hung;Chan, Henry Lik-Yuen
背景与目的：核苷类似物（NA）诱导的乙型肝炎表面抗原（HBsAg）血清清除是否持久尚不确定。我们研究了乙型肝炎表面抗体（anti-HBs）和巩固抗病毒治疗时间对HBsAg血清清除持久性的影响。方法：采用香港医院管理局的数据进行全港性队列研究。我们确定了2000年1月1日至2016年8月31日期间所有HBsAg阳性的受试者。检索NA使用、肝脏生化、系列HBsAg和anti-HBs结果。研究的主要终点是乙肝表面抗原（HBsAg）的血清清除率，定义至少两次乙肝表面抗原（HBsAg）检测结果为阴性，最后一次乙肝表面抗原检测结果为阴性的慢性乙型肝炎（CHB）患者。结果：共纳入4080例CHB患者进行分析。在自发HBsAg血清清除的患者中（n = 3563）， 1771例患者（49.7%）确认HBsAg血清清除，75例患者（2.1%）HBsAg血清恢复。在na诱导HBsAg血清清除的患者（n = 475）中，320例（67.4%）患者确认HBsAg血清清除，14例（2.9%）患者HBsAg血清恢复。确诊HBsAg血清清除率的5年累积概率在自发和na诱导的HBsAg血清清除率患者中具有可比性（88.1% vs. 92.2%； Log-rank检验，p = 0.964）；在接受na治疗的患者中，有或没有抗hbs的患者也相似（95.4% vs. 95.5%， Log-rank检验，p = 0.602）。仅在接受巩固治疗6-12个月的3例（2.0%）患者中观察到HBsAg血清逆转，而接受巩固治疗= 12个月的患者中没有观察到HBsAg血清逆转。结论：na诱导的HBsAg血清清除与自发的HBsAg血清清除一样持久。接受na治疗的患者在停止治疗前可能不需要抗体呈阳性。更长时间的巩固NA治疗可能导致更持久的HBsAg血清清除。摘要：我们调查了4080例乙型肝炎表面抗原（HBsAg）的血清清除率。自发的HBsAg血清清除率为2.1%，核苷类似物诱导的HBsAg血清清除率为2.9%。(C) 2017欧洲肝脏研究协会。Elsevier B.V.版权所有。
Background & Aims: It is uncertain if nucleos(t)ide analogue (NA)-induced hepatitis B surface antigen (HBsAg) seroclearance is durable. We investigated the impact of hepatitis B surface antibody (anti-HBs) and duration of consolidation antiviral therapy on the durability of HBsAg seroclearance.Methods: A territory-wide cohort study was conducted using data from the Hospital Authority, Hong Kong. We identified all subjects with positive HBsAg between January 1, 2000 and August 31, 2016. NA use, liver biochemistries, serial HBsAg and anti-HBs results were retrieved. The primary endpoint was confirmed HBsAg seroclearance, defined least two negative HBsAg test results, with the last HBsAg test being negative in patients with chronic hepatitis B (CHB).Results: A total of 4,080 CHB patients were included for analysis. In patients with spontaneous HBsAg seroclearance (n = 3,563), 1,771 patients (49.7%) had confirmed HBsAg seroclearance and 75 patients (2.1%) had HBsAg seroreversion. In patients with NA-induced HBsAg seroclearance (n = 475), 320 patients (67.4%) had confirmed HBsAg seroclearance and 14 patients (2.9%) had HBsAg seroreversion. The five-year cumulative probability of confirmed HBsAg seroclearance was comparable in patients with spontaneous and NA-induced HBsAg seroclearance (88.1% vs. 92.2%; Log-rank test, p = 0.964); it was also similar in patients with or without anti-HBs in NA-treated patients (95.4% vs. 95.5%, Log-rank test, p = 0.602). HBsAg seroreversion was only observed in 3 (2.0%) patients who had received consolidation therapy for 6-12 months and none of those who had received it for = 12 months.Conclusions: NA-induced HBsAg seroclearance is as durable as spontaneous HBsAg seroclearance. NA-treated patients may not need to have positive anti-HBs before stopping treatment. Longer consolidation NA treatment may result in more durable HBsAg seroclearance.Lay summary: We investigated 4,080 patients with hepatitis B surface antigen (HBsAg) seroclearance. HBsAg seroreversion occurred in 2.1% of patients with spontaneous and 2.9% of those with nucleos(t)ide analogues-induced HBsAg seroclearance. (C) 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.