【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。更多还原

【Abstract】 Objective To explore the influence of HBeAg seroconversion on virological relapse in HBeAg-positive chronic hepatitis B patients 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<1.0×103copies/ml,and every 3 month after HBV DNA<1.0×103copies/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 seroconversion,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 seroconversion,patients were assigned to the 3 groups(A,B,C) ≤ 12 months(11cases),12-24 months(23cases),> 24 months(12cases) respectively.The relapse rates of group A,B,and C at 6 months were 100%(11cases),47.8%(11cases),8.3%(1case)respectively,χ2=19.377,P=0.000.There was statistical significance between A group and B group,χ2=8.609,P=0.003;between A group and C group,χ2=19.326,P=0.000;between B group and C group,χ2=5.303,P=0.027.Conclusion HBeAg seroconversion can be seen as a basic end point in the treatment of chronic hepatitis B.when duration of additional treatment after HBeAg seroconversion are ≤ 12 months,relapse rate after drug withdrawal is still high.If the duration of additional treatment after HBeAg seroconversion are > 24 months,it is expected to gain sustained virological response,but all patients should be closely followed up within 6 months after the drug withdrawal.更多还原