摘要
目的探讨核苷(酸)类似物治疗慢性乙型肝炎患者HBV DNA阴转后HBsAg定量变化。方法选取2016年1月-2018年11月在联勤保障部队第九二二医院暨晓庄学院附属湘南医院感染内科予以核苷(酸)类似物规律治疗的慢性乙型肝炎患者,检测HBsAg定量和HBV DNA定量。HBV DNA阴转后HBsAg定量随治疗时间的分布差异采用χ~2检验进行分析。结果共采集到275例患者的560次HBsAg定量结果。抗病毒治疗2年、3年、4年、5年和5年后,HBsAg <20 IU/ml的患者占比分别为1. 2%、4. 0%、3. 7%、4. 3%和9. 4%;<200 IU/ml的分别为9. 9%、13. 6%、17. 1%、23. 4%和30. 2%;<1000 IU/ml的分别为40. 7%、38. 8%、56. 1%、70. 2%和67. 9%;<1500 IU/ml的分别为59. 3%、64. 8%、73. 2%、76. 6%和79. 2%,差异均有统计学意义(χ~2值分别为11. 186、21. 449、36. 341、27. 123,P值分别为0. 025、<0. 001、<0. 001、<0. 001)。治疗2年内,HBeAg阴性患者HBsAg <1000 IU/ml和1500 IU/ml的占比分别为45. 3%和64. 5%,高于HBeAg阳性患者的22. 0%和38. 0%,差异均有统计学意义(χ~2值分别为9. 039、11. 700,P值分别为0. 003、0. 001)。治疗第3年,HBeAg阴性患者HBsAg <1000 IU/ml和1500 IU/ml的占比分别为52. 6%和71. 1%,高于HBeAg阳性的28. 6%和42. 9%,差异均有统计学意义(χ~2值分别为5. 024、7. 617,P值分别为0. 025、0. 006)。162例有多次HBsAg定量随访的患者中,66例呈逐渐下降趋势,47例呈逐渐上升趋势。在其余49例HBsAg检测结果呈波动状态的患者中,30例最后1次检测结果与第1次相比呈下降状态,19例呈上升状态。结论慢性乙型肝炎患者核苷(酸)类似物治疗获得病毒学应答后,大部分可以延长疗程达到联合或序贯干扰素类药物治疗所需的理想HBsAg定量阈值,部分可达到停药所需的理想水平;但仍有部分患者可能即使无限延长疗程也无法达到理想终点。
Objective To investigate the change in HBsAg quantification after HBV DNA negative conversion in chronic hepatitis B (CHB) patients treated with nucleos(t)ide analogues (NAs). Methods The CHB patients who were treated with NAs in Department of Infectious Diseases,922 Hospital of PLA & Xiangnan Hospital Affiliated to Hunan Normal University,from January 2016 to November 2018 were enrolled. HBsAg quantitation and HBV DNA quantitation were measured. The chi-square test was used to investigate the difference in the distribution of HBsAg quantitation after HBV DNA negative conversion over the time of treatment. Results A total of 560 HBsAg quantification results were obtained from 275 patients. After 2,3,4,5,and >5 years of antiviral treatment,the proportion of patients with HBsAg <20 IU/ml was 1.2%,4.0%,3.7%,4.3%,and 9.4%,respectively (χ^2=11.186,P =0.025);the proportion of patients with HBsAg <200 IU/ml was 9.9%,13.6%,17.1%,23.4%,and 30.2%,respectively (χ^2=21.449,P <0.001);the proportion of patients with HBsAg <1000 IU/ml was 40.7%,38.8%,56.1%,70.2%,and 67.9%,respectively (χ^2=36.341,P <0.001);the proportion of patients with HBsAg <1500 IU/ml was 59.3%,64.8%,73.2%,76.6%,and 79.2%,respectively (χ^2=27.123,P <0.001). Within 2 years of treatment,the HBeAg-negative patients had a significantly higher proportion of patients with HBsAg <1000 IU/ml or <1500 IU/ml than the HBeAg-positive patients (45.3%/64.5% vs 22.0%/38.0%,χ^2= 9.039 and 11.700, P =0.003 and 0.001). In the third year of treatment,the HBeAg-negative patients had a significantly higher proportion of patients with HBsAg <1000 IU/ml or <1500 IU/ml than the HBeAg-positive patients (52.6%/71.1% vs 28.6%/42.9%,χ^2= 5.024 and 7.617, P =0.025 and 0.006). Among the 162 patients who had multiple HBsAg quantitation tests,66 had a gradual reduction in HBsAg quantitation,47 had a gradual increase,and 49 had fluctuations in HBsAg quantitation,among whom 30 had a reduction in HBsAg quantitation from the first test to the last test and 19 had an increase in HBsAg quantitation. Conclusion After achieving virologic response to NAs,most CHB patients can reach the ideal threshold for combined or sequential interferon therapy by prolonged treatment,and some patients can even reach the ideal threshold for drug withdrawal;however,there are still some patients who may not reach the ideal endpoint even if the treatment is extended.
作者
周友乾
李翠
尹凤鸣
张海艳
任彬
阳薇
ZHOU Youqian;LI Cui;YIN Fengming(Department of Infectious Diseases,922 Hospital of PLA & Xiangnan Hospital Affiliated to Hunan Normal University,Hengyang,Hunan 421002,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2019年第5期977-981,共5页
Journal of Clinical Hepatology
基金
湖南省卫生计生委课题(C2016096)
