HBeAg血清学转换对核苷(酸)类似物治疗慢性乙型肝炎患者停药后复发的影响  

Influence of HBeAg seroconversion on virological relapse in chronic hepatitis B patients on withdrawal of nucleos(t)ide analogues therapy

作　　者：梁延秀[1,2] 江建宁[1] 苏明华[1] 郭稳稳[1] 黄小红[1] 刘志红[1] 谢榕[1] 符武岛[1] 何丽霞[1] 钟少华[1] 

机构地区：[1]广西医科大学第一附属医院,南宁530021 [2]广西壮族自治区民族医院,南宁530000

出　　处：《临床肝胆病杂志》2011年第12期1275-1277,1290,共4页Journal of Clinical Hepatology

基　　金：广西自然科学基金(2010GXNSFD013046;桂科自0832117;桂科自0542092);广西医学科学实验中心开放基金资助项目(KFJJ2010-20)

摘　　要：目的探讨HBeAg血清学转换对核苷(酸)类似物治疗慢性乙型肝炎(CHB)患者停药后复发的影响。方法回顾性分析60例HBeAg阳性接受核苷(酸)类似物治疗的CHB患者,疗程至少1年的停药患者,于基线、治疗后每个月、HBV DNA转阴后每3个月检测ALT,HBV DNA,HBeAg和抗-HBe。停药后继续随访至少6个月,观察停药后复发情况。分析停药时是否发生HBeAg消失/转换对复发的影响;比较发生HBeAg/抗HBe血清转换后巩固治疗≤12个月、12～24个月、>24个月三组患者的复发率。结果 60例患者中,60%(36例)的患者在停药后6个月内复发。8例患者未发生HBeAg消失(A组),停药后4个月内100%复发;6例患者发生HBeAg消失,但无抗-HBe(B组),停药后6个月内83.3%(5例)复发;46例发生HBeAg血清学转换(C组),停药后6个月内50%(23例)复发,χ2=11.585,P=0.003,A组与C组相比,χ2=6.84,P=0.015,差异有统计学意义;B组与A组、C组相比,χ2=1.333,P=0.248,χ2=2.327,P=0.199,差异无统计学意义;HBeAg/抗-HBe血清转换后继续用药≤12个月(11例)、12～24个月(23例)、>24个月(C组12例),停药后6个月内复发率分别为100%(11例)、47.8%(11例)、8.3%(1例),χ2=19.377,P=0.000,A组与B组、C组相比,χ2=8.609,P=0.003,χ2=19.326,P=0.000,B组与C组相比,χ2=5.303,P=0.027,均有统计学意义。结论 HBeAg血清学转换是HBeAg阳性CHB患者治疗终点的基本指标,HBeAg/抗-HBe血清转换后治疗≤12个月仍有较高的复发率,HBeAg/抗-HBe血清转换继续治疗>24个月有望获得持久的病毒学应答,但对停药患者6个月内应密切随访观察。Objective To explore the influence of HBeAg seroconversion on virological relapse in HBeAg - positive chronic hepatitis B pa- tients who stopped nucleos（t） ide analogues therapy. Methods We retrospectively studied 60 HBeAg -positive chronic hepatitis B （CHB） patients who had stopped nucleos（t） ide analogues therapy. The total duration of treatment was ≥ 12 months. ALT, HBV DNA and HBV serological markers were measured respectively at baseline, every month before HBV DNA 〈 1.0 ×103 copies/ml, and every 3 month after HBV DNA 〈 1.0 x 103 copies/ml. After the drug withdrawal, we continued to follow up for at least 6 months, to observe whether or not there were relapse. HBeAg loss/seroconversion occurred at the end of the therapy were analyzed for relapse. For those patients who had HBeAg se- roconversion, relapse rates in 3 groups according to duration of additional treatment （ ≤12 months, 12 -24 months, 〉 24 months） were compared. Results Of 60 patients, 60% （36cases） relapsed within 6 months. 8 cases were without HBeAg loss （ A）, 100% relapsed within 4 months after drug withdrawal; 6 cases occurred HBeAg loss but without HBeAb（ B）, 83.3% （5 cases） relapsed within 6 months; 46 cases occurred HBeAg seroconversion （ C）, 50% （23 cases） relapsed within 6 months, χ2 = 11. 585, P = 0. 003. There was statistical significance between A group and C group, χ2 = 6.84, P = 0. 015 ;But there was no statistical significance between B group and A group , χ2 = 1. 333 ,P = 0. 248, and between B group and C group , χ2 = 2. 327 ,P = 0. 199; For 46 patients who occurred HBeAg seroeonversion,patients were assigned to the 3 groups（A, B, C） ≤ 12 montbs（llcases）, 12 -24 months （23cases）, 〉 24 months （12cases） respectively. 3＂he relapse rates of group A, B, and C at 6 months were 100% （ llcases）, 47.8% （ llcases）, 8.3% （lcase） respectively, 22 = 19. 377, P =0. 000. There was statistical significance between A group and B group, 22 =8.609 ,P =0.003 ;bet

关 键 词：肝炎 乙型 慢性 肝炎E抗原 复发 

分 类 号：R512.62[医药卫生—内科学]