Lower end of treatment HBsAg and HBcrAg were associated with HBsAg loss after nucleos(t)ide analog cessation.
Lower end of treatment HBsAg and HBcrAg were associated with HBsAg loss after nucleos(t)ide analog cessation.
复制标题
DOI：
10.1186/s12876-023-02852-x
复制
发表时间：
2023-06-29
影响因子：
2.4
通讯作者：
Feng, Bo
中科院分区：
文献类型：
--
作者：
Xie, Yandi;Li, Minghui;Ou, Xiaojuan;Zheng, Sujun;Gao, Yinjie;Xu, Xiaoyuan;Yang, Ying;Ma, Anlin;Li, Jia;Nan, Yuemin;Zheng, Huanwei;Liu, Juan;Wei, Lai;Feng, Bo
关键词：
由于B型肝炎表面抗原（HBsAg）丢失很少通过核苷（酸）类似物（NA）治疗实现，因此大多数患者需要终身NA治疗。先前的研究表明，一些患者即使在停止NA后仍保持病毒学应答。然而，关于NA停药是否会增加HBsAg丢失率仍存在争议。因此，本研究旨在评估HBsAg丢失的累积率，并确定NA停药后HBsAg丢失的预测因素。这项多中心前瞻性研究纳入了来自中国12家医院的符合纳入标准的HBV e抗原（HBeAg）阳性且无肝硬化的患者。入组的患者停止NA，并在NA停止后24个月内每3个月进行一次临床和实验室评估，直至发生临床复发（CR）。总体而言，158例患者被分为两组。A组包括NA停止时HBsAg阳性的患者（n = 139），B组包括NA停止时HBsAg阴性的患者（n = 19）。A组12个月和24个月HBsAg累积丢失率分别为4.3%和9.4%。治疗结束（EOT）HBsAg（风险比（HR）= 0.152，P < 0.001）和EOT B型肝炎核心相关抗原（HBcrAg）（HR = 0.257，P = 0.001）与HBsAg丢失相关。EOT时HBsAg和HBcrAg水平的受试者工作特征曲线下面积分别为0.952（P < 0.001）和0.765（P < 0.001）。EOT HBsAg ≤ 135 IU/mL（59.2% vs. 1.3%，P < 0.001）或HBcrAg ≤ 3.6 logU/mL（17% vs. 5.4%，P = 0.027）的患者24个月累积HBsAg丢失率较高。在B组中，没有患者在NA停止后经历病毒学复发。仅1例（5.3%）患者发生HBsAg逆转。EOT HBsAg ≤ 135 IU/mL或HBcrAg ≤ 3.6 logU/mL可用于识别NA停止后HBsAg丢失可能性较高的患者。停用NA后HBsAg阴性的患者具有良好的临床结局，大多数情况下HBsAg丢失是持久的。
Since hepatitis B surface antigen (HBsAg) loss is rarely achieved with nucleos(t)ide analog (NA) treatment, most patients require life-long NA treatment. Previous studies have shown that some patients remain virologically responsive even after NA cessation. However, there is still controversy surrounding whether NA discontinuation increases the HBsAg loss rate. Therefore, this study aimed to assess the cumulative rate of HBsAg loss and identify the predictors of HBsAg loss after NA discontinuation. This multicenter prospective study included HBV e antigen (HBeAg)-positive patients without cirrhosis from 12 hospitals in China who met the inclusion criteria. The enrolled patients stopped NA and were followed up with clinical and laboratory assessments every 3 months for 24 months after NA cessation or until clinical relapse (CR) occurred. Overall, 158 patients were classified into two groups. Group A included patients with HBsAg positivity at NA cessation (n = 139), and Group B included patients with HBsAg negativity at NA cessation (n = 19). In Group A, the 12-month and 24-month cumulative rates of HBsAg loss were4.3%and 9.4%, respectively. End of treatment (EOT) HBsAg (hazard ratio (HR) = 0.152, P < 0.001) and EOT hepatitis B core-related antigen (HBcrAg) (HR = 0.257, P = 0.001) were associated with HBsAg loss. The areas under the receiver operating characteristic curves for EOT HBsAg and HBcrAg levels were 0.952 (P < 0.001) and 0.765 (P < 0.001), respectively. Patients with EOT HBsAg ≤ 135 IU/mL (59.2% vs. 1.3%, P < 0.001) or HBcrAg ≤ 3.6 logU/mL (17% vs. 5.4%, P = 0.027) had a higher 24-month cumulative HBsAg loss rate. In Group B, none of the patients experienced virological relapse after NA cessation. Only 1 (5.3%) patient had HBsAg reversion. EOT HBsAg ≤ 135 IU/mL or HBcrAg ≤ 3.6 logU/mL can be used to identify patients with a higher likelihood of HBsAg loss after NA cessation. Patients with HBsAg negativity after NA cessation have favorable clinical outcomes, and HBsAg loss was durable in most cases.
登录
查看更多内容
影响因子：
25.7
作者：
Pfefferkorn, Maria;Schott, Tina;van Boemmel, Florian
通讯作者：
van Boemmel, Florian
影响因子：
11.8
作者：
Chu, Chia-Ming;Liaw, Yun-Fan
通讯作者：
Liaw, Yun-Fan
影响因子：
24.5
作者：
Kim, Gi-Ae;Lim, Young-Suk;Suh, Dong Jin
通讯作者：
Suh, Dong Jin
影响因子：
12.6
作者：
Chen, Chien-Hung;Hung, Chao-Hung;Lee, Chuan-Mo
通讯作者：
Lee, Chuan-Mo
影响因子：
14.2
作者：
Chen, C. -H.;Hung, C. -H.;Lee, C. -M.
通讯作者：
Lee, C. -M.