核苷和核苷酸类药物治疗慢性乙型肝炎停药标准的探讨

陈合民; 邵国辉

doi:10.3969/j.issn.1001-5256.2016.07.013

核苷和核苷酸类药物治疗慢性乙型肝炎停药标准的探讨

DOI: 10.3969/j.issn.1001-5256.2016.07.013

济宁市传染病医院

基金项目:

山东省济宁市科技项目(2013jnnk09)；

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中图分类号: R512.62
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出版历程
- 收稿日期: 2016-01-21
- 出版日期: 2016-07-20

Criteria for withdrawal of nucleos( t) ide analogues and their clinical significance in treatment of chronic hepatitis B

Jining Infectious Diseases Hospital

Research funding:

摘要

摘要: 目的探讨核苷和核苷酸类药物（NAs）治疗慢性乙型肝炎（CHB）停药后病毒学复发与停药时HBs Ag定量、HBV DNA载量的关系。方法收集2010年1月-2014年6月于济宁市传染病医院门诊经NAs治疗达到《慢性乙型肝炎防治指南（2010年版）》制订的停药标准计划停药的CHB患者205例。停药前检测HBs Ag定量、HBV DNA载量,其中HBV DNA<103IU/ml的采用Roche COBAS Taq Man 480ⅡPCR进一步检测高灵敏度HBV DNA载量。停药后随访1年,HBV DNA载量>103IU/ml定义为病毒学复发。计数资料组间比较采用χ2检验和Fisher精确检验。结果停药1年所有CHB患者的总病毒学复发率为65.9%（135/205）。20%（41/205）患者HBV DNA>103IU/ml。HBs Ag定量≤100 IU/ml患者的复发率为23.9%（11/46）,>100 IU/ml患者的复发率为78.0%（124/159）,两组比较差异有统计学意义（χ2=46.4,P<0.000 ...
- 肝炎,乙型,慢性 /
- 核苷类 /
- 核苷酸类 /
- 复发
Abstract: Objective To investigate the association of virologic relapse after withdrawal of nucleos( t) ide analogues( NAs) with HBs Ag quantitation and HBV DNA load at withdrawal in patients with chronic hepatitis B( CHB). Methods A total of 205 CHB patients who were treated with NAs in the outpatient service of Jining Infectious Diseases Hospital from January 2010 to June 2014,met the criteria for drug withdrawal in Guidelines for Prevention and Treatment of Chronic Hepatitis B( version 2010),and planned to stop the drugs were enrolled.HBs Ag and HBV DNA load were measured before drug withdrawal,and COBAS Taq Man 480 Ⅱ PCR was performed for patients with HBV DNA < 103 IU / ml to measure highly sensitive HBV DNA load. The patients were followed up for 1 year after drug withdrawal and HBV DNA > 103 IU / ml was defined as virologic relapse. The chi- square test and Fisher' s exact test were used for comparison of categorical data between groups. Results At 1 year after drug withdrawal,the overall virologic relapse rate in all CHB patients was 65. 9%( 135 /205),and 20%( 41 /205) had HBV DNA >103 IU / ml. In the patients with HBs Ag quantitation ≤100 IU / ml or >100 IU / ml,the virologic relapse rate was23. 9%( 11 /46) and 78. 0%( 124 /159),respectively,with a significant difference between the two groups( χ2= 46. 4,P < 0. 000 1). In the patients with highly sensitive HBV DNA load < 20 IU / ml or ≥20 IU / ml,the virologic relapse rate was 56. 4%( 62 /110) and 76. 8%( 73/95),respectively,with a significant difference between the two groups( χ2= 9. 5,P = 0. 002). The patients with HBs Ag quantitation ≤100IU / ml and highly sensitive HBV DNA load < 20 IU / ml had a relapse rate of 14. 3%( 5 /35),and the other patients had a relapse rate of76. 5%( 130 /170); the relapse rate showed a significant difference between the two groups( χ2= 49. 9,P <0. 000 1). Conclusion After the patients meet the criteria for drug withdrawal in Guidelines for Prevention and Treatment of Chronic Hepatitis B( version 2010) and stop the antiviral therapy,the relapse of CHB is associated with HBs Ag quantitation and HBV DNA load at withdrawal. With reference to HBs Ag quantitation and / or highly sensitive HBV DNA load as the criteria for withdrawal of antiviral therapy,such as HBs Ag quantitation ≤100 IU / ml and highly sensitive HBV DNA load < 20 IU / ml,patients can achieve the safest drug withdrawal.
- hepatitis B /
- chronic /
- nucleosides /
- nucleotides

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参考文献(17)

[1]European Association for the Study of the Liver.EASL clinical practice guidelines:management of chronic hepatitis B virus infection[J].J Hepatol,2012,57(1):167-185.

[2]LIAW YF,KAO JH,PIRATVISUTH T,et al.Asian-Pacific consensus statement on the management of chronic hepatitis B:a 2012 update[J].Hepatol Int,2012,6(3):531-561.

[3]LOK AS,McM AHON BJ.Chronic hepatitis B:update 2009[J].Hepatology,2009,50(3):661-662.

[4] Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B(2010 version)[J].Clin JHepatol,2011,19(1):13-24.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].中华肝脏病杂志,2011,19(1):13-24.

[5]HA M,ZHANG G,DIAO S,et al.A prospective clinical study in hepatitis B e antigen-negative chronic hepatitis B patients with stringent cessation criteria for adefovir[J].Arch Virol,2012,157(2):285-290.

[6]LIANG Y,JIANG J,SU M,et al.Predictors of relapse in chronic hepatitis B after discontinuation of anti-viral therapy[J].Alment Pharmacol Ther,2011,34(3):344-352.

[7]CHEN L,LI XL,GAN QR,et al.Clinical characteristics of and factors related to relapse in chronic hepatitis B patients after nucleot(s)ide analogues withdrawal[J].Chin J Hepatol,2013,21(11):825-828.(in Chinese)陈立,李孝楼,甘巧蓉,等.核苷(酸)类似物治疗慢性乙型肝炎停药复发患者的临床特点及其影响因素[J].中华肝脏病杂志,2013,21(11):825-828.

[8]MAO Q.Current status of antiviral therapy in patients with chronic hepatitis B virus infection and related thoughts[J].J Pract Hepatol,2013,16(4):289-292.(in Chinese)毛青.慢性乙型肝炎病毒感染者抗病毒治疗的现状与思考[J].实用肝脏病杂志,2013,16(4):289-292.

[9]KWON JH,JANG JW,CHOI JY,et al.Should lamivudine monotherapy be stopped or continued in patients infected with hepatitis B with favorable responses after more than 5 years of treatment?[J].J Med Virol,2013,85(1):34-42.

[10]CAI W,XIE Q,AN B,et al.On-treatment serum HBsA g level is predictive of sustained off-treatment virologic response to telbivudine in HBeA g-positive chronic hepatitis B patients[J].J Clin Virol,2010,48(1):22-26.

[11]CHEN CH,LU SN,HUNG CH,et al.The role of hepatitis B surface antigen quantification in predicting HBsA g loss and HBV relapse after discontinuation of lamivudine treatment[J].J Hepatol,2014,61(3):515-522.

[12]CHEN CH,HUNG CH,HU TH,et al.Association between level of hepatitis B surface antigen and relapse after entecavir therapy for chronic hepatitis B virus infection[J].Clin Gastroenterol Hepatol,2015,13(11):1984-1992.

[13]LEE HC,SUH DJ,RYU SH,et al.Quantitative polymerase chain reaction assay for serum hepatitis B virus DNA as a predictive factor for post-treatment relapse after lamivudine induced hepatitis B e antigen loss or seroconversion[J].Gut,2003,52(12):1779-1783.

[14]SONG BC,CUI XJ,CHO YK,et al.New scoring system for predicting relapse after lamivudine-induced hepatitis B e-antigen loss in chronic hepatitis B patients[J].Hepatol Res,2009,39(11):1064-1071.

[15]JIANG JN,HUANG ZL,HE LX,et al.Residual amount of HBVDNA in serum is related to relapse in chronic hepatitis B patients after cessation of nucleos(t)ide analogs[J].J Clin Gastroenterol,2015,49(4):323-328.

[16] LOK AS,McM AHON BJ.Chronic hepatitis B[J].Hepatology,2007,45(2):507-539.

[17]ZHUANG H,WENG XH.Discussion of discontinuation of nucleoside and nucleotide analogs in the treatment of chronic hepatitis B[J].Chin J Viral Dis,2013,3(4):241-244.(in Chinese)庄辉,翁心华.核苷(酸)类似药物治疗慢性乙型肝炎停药的探讨[J].中国病毒病杂志,2013,3(4):241-244.

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