摘要
目的探讨核苷(酸)类似物治疗乙型肝炎肝硬化代偿期患者HBsAg消失后停药的安全性。方法收集2008年1月至2020年12月于台州医院、台州市立医院、台州恩泽医院使用核苷(酸)类药物治疗的3783例乙型肝炎肝硬化代偿期患者中85例HBsAg消失后停药或继续用药患者在HBsAg消失时及随访48个月的丙氨酸转氨酶(ALT)、HBV血清学标志物、HBV DNA载量及影像学资料,并进行回顾性研究。采用χ^(2)检验和秩和检验对数据进行统计学分析。结果85例患者中停药36例,继续用药49例。两组患者HBsAg消失时,随访24和48个月时,ALT水平均在正常范围内;停药组抗-HBs阳性率与继续用药组相比差异均无统计学意义(χ^(2)=0.75、0.39和0.90,P=0.78、0.84和0.34)。HBeAg阳性率与继续用药组相比差异亦无统计学意义(χ^(2)=0.40、0.00和0.00,P=0.84、1.00和1.00)。随访48个月时,停药组原发性肝癌发生2例,继续用药组无原发性肝癌发生,两组比较差异无统计学意义(χ^(2)=0.89,P=0.34)。整个随访中,HBsAg均为阴性,HBV DNA载量均低于检测下限。结论乙型肝炎肝硬化代偿期患者HBsAg消失后可考虑停用核苷(酸)类似物。
Objective To evaluate the safety of discontinuing nucleoside/nucleoside analogue(NAs)therapy in patients with compensated hepatitis B cirrhosis after HBsAg negative conversion.Methods A total of 3783 patients with hepatitis B cirrhosis in compensated stage were treated with NAs at Taizhou Hospital,Taizhou Municipal Hospital and Taizhou Enze Hospital from January 2008 to December 2020.The clinical data and laboratory tests results of 85 patients with HBsAg negative conversion were retrospectively analyzed,including 36 cases discontinued the drug,and 49 continued to use drug.Chi-square test and rank-sum test were used for data analysis.Results During the 24 and 48 months of follow-up,the ALT levels were within the normal range in both groups.There were no significant differences in positive rates of anti-HBs and HBeAg(χ^(2)=0.75,0.39 and 0.90,P=0.780.84 and 0.34;χ^(2)=0.40,0.00 and 0.00,P=0.84,1.00 and 1.00)between two groups.After 48 months of follow-up,2 cases of primary liver cancer occurred in the discontinuation group and no primary liver cancer occurred in the continuation group(χ^(2)=0.89,P=0.34).Throughout the follow-up,HBsAg remained negative and HBV DNA load was below the lower limit of detection in both groups.Conclusions Discontinuation of NAs can be considered after the HBsAg negative conversion in patients with compensated hepatitis B cirrhosis.
作者
刘海燕
陈华忠
邢同京
涂文辉
应灵军
冯江
汤永志
Liu Haiyan;Chen Huazhong;Xing Tongjing;Tu Wenhui;Ying Lingjun;Feng Jiang;Tang Yongzhi(Medical College of Shaoxing University,Shaoxing 312099,Zhejiang Province,China;Zhejiang Key Laboratory of Accurate Diagnosis,Treatment and Transformation of Severe Chronic Liver Disease,Department of Infectious Diseases,Taizhou Hospital Affiliated to Wenzhou Medical University,Taizhou 317000,Zhejiang Province,China;Department of Infectious Diseases,Taizhou Municipal Hospital,Taizhou 318099,Zhejiang Province,China;Department of Infectious Diseases,Taizhou Enze Hospital,Taizhou 318053,Zhejiang Province,China;Taizhou Hospital Affiliated to Wenzhou Medical University)
出处
《中华临床感染病杂志》
CAS
CSCD
2022年第1期16-20,共5页
Chinese Journal of Clinical Infectious Diseases
关键词
乙型肝炎
肝硬化代偿期
核苷(酸)类似物
乙肝表面抗原消失
停药
安全性
Hepatitis B
Compensatory stage of liver cirrhosis
Nucleoside/nucleoside analogues
Hepatitis B surface antigen disappearance
Drug withdrawal
Safety
