AIM： To determine the predictive factors for hepatocellular carcinoma （HCC） development in patients after spontaneous or therapeutic HBeAg seroconversion. METHODS： In 48 patients who seroconverted to anti- HBe pos...AIM： To determine the predictive factors for hepatocellular carcinoma （HCC） development in patients after spontaneous or therapeutic HBeAg seroconversion. METHODS： In 48 patients who seroconverted to anti- HBe positive during follow-up, the background factors for HCC development were analyzed. RESULTS： HCC was developed in six patients during follow-up （average follow-up after HBeAg seroconversion： 10.9±5.4 years）. The incidence of HCC evaluated by Kaplan-Meier analysis was significantly higher in patients with abnormal aspartate aminotransferase （AST〉 40 IU/L） level, lower platelet counts （PLT〈10×10^4/IJL）, lower albumin level （Alb〈30 g/L）, positive HBV-DNA or older age at seroconversion （〉40 years）. However, lower platelet count was the only predictive factor for HCC development shown by multivariate proportional-hazard analysis. CONCLUSION： Active hepatitis or advanced hepatitis at HBeAg seroconversion or progressive hepatitis even after HBeAg seroconversion would be the risk factors for HCC development. These predictive factors should be taken into account in determining the frequency of biochemical study or imaging studies for HCC surveillance.展开更多
Objective: To identify the impact of lamivudine on HBV e antigen (HBeAg) seroconversion and HBV DNA level, and the appearance of Tyr-Met-Asn-Asp (YMDD) resistants. Methods: Forty-seven hepatitis B patients were trea- ...Objective: To identify the impact of lamivudine on HBV e antigen (HBeAg) seroconversion and HBV DNA level, and the appearance of Tyr-Met-Asn-Asp (YMDD) resistants. Methods: Forty-seven hepatitis B patients were trea- ted with oral lamivudine. ALT level and HBeAg were detected in the treatment on the zero, 3rd, 6th and 9th month respectively. The levels of HBV DNA and YMDD resistants were analyzed with PCR mi- croplate hybridization-ELISA. Results: After 9 months of treatment, HBV DNA be- came negative and ALT level was normal in 74% pa- tients. Among these patients, 17% patients had HBeAg converted to negative and anti-HBe antibody positive, whereas another 15% patients showed HBeAg negative. YMDD resistants appeared in 19 % patients (9/47). One, three and five resistants were detected in the treatment on the 3rd, 6th and 9th month respectively. Conclusions: Most HBV DNA in serum became nega- tive after 9 months of treatment, and the rate of HBeAg seroconversion was 17% (HBV DNA level was lower than 100 pg/ml before treatment). YMDD resistants appeared in 19% patients.展开更多
Background Some hepatitis B extracellular antigen （HBeAg）-positive chronic hepatitis B （CHB） patients in their immune active phase can clear the virus spontaneously and enter into an inactive hepatitis B virus （...Background Some hepatitis B extracellular antigen （HBeAg）-positive chronic hepatitis B （CHB） patients in their immune active phase can clear the virus spontaneously and enter into an inactive hepatitis B virus （HBV） carrier state,indicating a benign prognosis.In this study,the association between cytokine-inducibie SRC homology 2 domain protein （C/SH） gene polymorphisms at-292 （rs414171） and the spontaneous clearance of HBV in HBeAg-positive CHB patients in immune the active phase was investigated.Methods Seventy HBeAg-positive CHB patients in the immune active phase were followed up for 76 weeks without antiviral therapy.The alanine transaminase,aspartate transaminase,HBV DNA,HBeAg and hepatitis B extracellular antibody levels were tested regularly.At week 76,27 patients were classified into group A （HBV DNA level below 2 104 IU/ml and the value of HBeAg declined below 10％ of the baseline at week 76）,and 43 patients were classified into group B （HBV DNA level higher than 2×104 IU/ml or the value of HBeAg did not decline substantially at week 76）.CISH （rs414171） polymorphisms were also tested using the iPLEX system.Results The HBV DNA levels at week 12 were significantly greater in group B compared with group A （group A：（6.87±1.40） log10IU/ml; group B：（7.61±1.38） log10IU/ml,P=0.034） and the HBeAg values were greater in group B at week 28 compared with group A （P=0.001）.The differences in HBV DNA and HBeAg values increased between the groups over time.Sixteen patients in group A and 11 in group B were genotype AA.Those with genotype AT or TT included 11 in group A and 31 in group B （AA vs.AT and TT,odds ratio 4.10 （95％ confidence interval：1.462-11.491）,P=0.006）.Conclusion CISH gene polymorphisms at-292 （rs414171） are associated with HBV clearance in HBeAg-positive CHB patients in the immune active phase,and AA is a favorable genotype for this effect.展开更多
Background and Aims:The use of additional nucleos(t)ide analogues(NAs)without cross-resistance to previously used NAs as a rescue therapy is recommended by most international guidelines for chronic hepatitis B patient...Background and Aims:The use of additional nucleos(t)ide analogues(NAs)without cross-resistance to previously used NAs as a rescue therapy is recommended by most international guidelines for chronic hepatitis B patients with NAresistance.We aimed to investigate the efficacy and safety of combination therapy of peg-interferon(PegIFN)alfa-2a and NA in these patients,comparing to those who switch to an alternative NA therapy without cross-resistance.Methods:In this prospective,comparative and cohort study,data were collected from the patients'hospital records.Eligible patients were those with hepatitis B e antigen(HBeAg)positivity and resistance to one or more NAs.All patients were treated with alternative NA alone or in combination with PegIFN alfa-2a for 52 weeks or 72 weeks,respectively.HBeAg seroconversion was measured at the end of follow-up(EOF;more than 104 weeks after the end of treatment).Results:Sixty-three patients were recruited to the cohort study(NAtherapy group=31 patients;combination therapy group of NA and PegIFN alfa-2a=32 patients).At the EOF,significantly more patients in the combination therapy group(13/27,48.2%)achieved primary outcome of HBeAg seroconversion than those in the NA therapy group(4/32,12.5%)(p=0.003).Four patients(14.8%)in the combination therapy group achieved hepatitis B surface antigen(HBsAg)loss and HBsAg seroconversion,but none in the NA therapy group did(p=0.039).In the combination therapy group,16 patients(51.6%)achieved HBeAg seroconversion at the end of treatment,of which,11 patients(68.8%)maintained the response until EOF.Conclusions:Adding on PegIFN alfa-2a in combination with NA therapy might be an appropriate rescue treatment option for patients who have prior NA resistance.In addition,combination therapy induced sustained off-treatment biochemical responses in these patients.展开更多
文摘AIM： To determine the predictive factors for hepatocellular carcinoma （HCC） development in patients after spontaneous or therapeutic HBeAg seroconversion. METHODS： In 48 patients who seroconverted to anti- HBe positive during follow-up, the background factors for HCC development were analyzed. RESULTS： HCC was developed in six patients during follow-up （average follow-up after HBeAg seroconversion： 10.9±5.4 years）. The incidence of HCC evaluated by Kaplan-Meier analysis was significantly higher in patients with abnormal aspartate aminotransferase （AST〉 40 IU/L） level, lower platelet counts （PLT〈10×10^4/IJL）, lower albumin level （Alb〈30 g/L）, positive HBV-DNA or older age at seroconversion （〉40 years）. However, lower platelet count was the only predictive factor for HCC development shown by multivariate proportional-hazard analysis. CONCLUSION： Active hepatitis or advanced hepatitis at HBeAg seroconversion or progressive hepatitis even after HBeAg seroconversion would be the risk factors for HCC development. These predictive factors should be taken into account in determining the frequency of biochemical study or imaging studies for HCC surveillance.
文摘Objective: To identify the impact of lamivudine on HBV e antigen (HBeAg) seroconversion and HBV DNA level, and the appearance of Tyr-Met-Asn-Asp (YMDD) resistants. Methods: Forty-seven hepatitis B patients were trea- ted with oral lamivudine. ALT level and HBeAg were detected in the treatment on the zero, 3rd, 6th and 9th month respectively. The levels of HBV DNA and YMDD resistants were analyzed with PCR mi- croplate hybridization-ELISA. Results: After 9 months of treatment, HBV DNA be- came negative and ALT level was normal in 74% pa- tients. Among these patients, 17% patients had HBeAg converted to negative and anti-HBe antibody positive, whereas another 15% patients showed HBeAg negative. YMDD resistants appeared in 19 % patients (9/47). One, three and five resistants were detected in the treatment on the 3rd, 6th and 9th month respectively. Conclusions: Most HBV DNA in serum became nega- tive after 9 months of treatment, and the rate of HBeAg seroconversion was 17% (HBV DNA level was lower than 100 pg/ml before treatment). YMDD resistants appeared in 19% patients.
文摘Background Some hepatitis B extracellular antigen （HBeAg）-positive chronic hepatitis B （CHB） patients in their immune active phase can clear the virus spontaneously and enter into an inactive hepatitis B virus （HBV） carrier state,indicating a benign prognosis.In this study,the association between cytokine-inducibie SRC homology 2 domain protein （C/SH） gene polymorphisms at-292 （rs414171） and the spontaneous clearance of HBV in HBeAg-positive CHB patients in immune the active phase was investigated.Methods Seventy HBeAg-positive CHB patients in the immune active phase were followed up for 76 weeks without antiviral therapy.The alanine transaminase,aspartate transaminase,HBV DNA,HBeAg and hepatitis B extracellular antibody levels were tested regularly.At week 76,27 patients were classified into group A （HBV DNA level below 2 104 IU/ml and the value of HBeAg declined below 10％ of the baseline at week 76）,and 43 patients were classified into group B （HBV DNA level higher than 2×104 IU/ml or the value of HBeAg did not decline substantially at week 76）.CISH （rs414171） polymorphisms were also tested using the iPLEX system.Results The HBV DNA levels at week 12 were significantly greater in group B compared with group A （group A：（6.87±1.40） log10IU/ml; group B：（7.61±1.38） log10IU/ml,P=0.034） and the HBeAg values were greater in group B at week 28 compared with group A （P=0.001）.The differences in HBV DNA and HBeAg values increased between the groups over time.Sixteen patients in group A and 11 in group B were genotype AA.Those with genotype AT or TT included 11 in group A and 31 in group B （AA vs.AT and TT,odds ratio 4.10 （95％ confidence interval：1.462-11.491）,P=0.006）.Conclusion CISH gene polymorphisms at-292 （rs414171） are associated with HBV clearance in HBeAg-positive CHB patients in the immune active phase,and AA is a favorable genotype for this effect.
基金The study was supported by the Third People's Hospital of Kunming City, Kunming, China
文摘Background and Aims:The use of additional nucleos(t)ide analogues(NAs)without cross-resistance to previously used NAs as a rescue therapy is recommended by most international guidelines for chronic hepatitis B patients with NAresistance.We aimed to investigate the efficacy and safety of combination therapy of peg-interferon(PegIFN)alfa-2a and NA in these patients,comparing to those who switch to an alternative NA therapy without cross-resistance.Methods:In this prospective,comparative and cohort study,data were collected from the patients'hospital records.Eligible patients were those with hepatitis B e antigen(HBeAg)positivity and resistance to one or more NAs.All patients were treated with alternative NA alone or in combination with PegIFN alfa-2a for 52 weeks or 72 weeks,respectively.HBeAg seroconversion was measured at the end of follow-up(EOF;more than 104 weeks after the end of treatment).Results:Sixty-three patients were recruited to the cohort study(NAtherapy group=31 patients;combination therapy group of NA and PegIFN alfa-2a=32 patients).At the EOF,significantly more patients in the combination therapy group(13/27,48.2%)achieved primary outcome of HBeAg seroconversion than those in the NA therapy group(4/32,12.5%)(p=0.003).Four patients(14.8%)in the combination therapy group achieved hepatitis B surface antigen(HBsAg)loss and HBsAg seroconversion,but none in the NA therapy group did(p=0.039).In the combination therapy group,16 patients(51.6%)achieved HBeAg seroconversion at the end of treatment,of which,11 patients(68.8%)maintained the response until EOF.Conclusions:Adding on PegIFN alfa-2a in combination with NA therapy might be an appropriate rescue treatment option for patients who have prior NA resistance.In addition,combination therapy induced sustained off-treatment biochemical responses in these patients.
