目的 探索HBeAg阴性慢性乙型肝炎(chronic hepatitis B,CHB)患者抗病毒药物停用1年后丙氨酸氨基转移酶(alanine aminotransferase, ALT)水平变化、病毒学应答特点。方法 收集解放军总医院第五医学中心采用核苷酸类似物(nucleotide analogue, NUC)治疗,符合纳入标准的e抗原阴性CHB患者的临床资料,分析停药时及停药随访一年患者的病历资料。结果 自2017-01至2020-07,共有40例符合纳入标准的CHB患者。其中HBeAg阳性19例,HBeAg阴性21例。HBeAg阴性比HBeAg阳性患者停药后更易出现HBV DNA的复阳(P=0.031)和ALT水平升高(P=0.017)。HBeAg阴性患者停药后,HBV DNA复阳者1、3、6、12个月时HBsAg滴度有逐渐下降趋势,与HBV DNA阴性组比较均有统计学差异。HBV DNA复阳患者转氨酶有逐渐升高趋势,仅1例患者出现乙肝复燃。结论 HBeAg阴性CHB患者停药1年后,HBV DNA复阳率高,多伴有转氨酶升高,但临床观察安全。HBV DNA复阳患者HBsAg滴度有逐渐下降趋势,可能会增加患者远期HBsAg转阴率,提高治愈率,并减轻患者经济负担。
Abstract
Objective To observe the patterns of viral responses and changes of alanine aminotransferase (ALT) levels in HBeAg-negative patients one year after withdrawal of antiviral drugs.Methods The clinical data on HBeAg negative chronic hepatitis B patients (CHB) who took nucleotide analogues (NAs) and met the inclusion criteria was collected in our hospital. The clinical characteristics at the time of withdrawal of NAs and one year after treatment were analyzed. Results From January 2017 to July 2020, there were 40 CHB patients who met the inclusion criteria, 19 of whom were HBeAg positive and 21 were HBeAg negative. HBeAg-negative patients were more likely to have their HBV DNA rebounded(P=0.031) and ALT elevated(P=0.017) than HBeAg- positive patients after withdrawal of NAs. HBeAg-negative patients with rebounding HBV DNA after withdrawal of NAs had their HBsAg titers gradually decreased in the 1st month, 3rd month, 6th month, and 12th month. There was statistically significant difference compared with the HBV DNA-negative group. The ALT levels of patients with rebounding HBV DNA gradually increased, but hepatitis B reoccurred only in one patient.Conclusions One year after withdrawal of NAs, the rebound rate of HBV DNA is high and the ALT level is elevated in HBeAg negative patients.For patients with rebounding HBV DNA, HBsAg titers are decreased, which might contribute to the clearance of HBsAg in the long run.
关键词
慢性乙型肝炎 /
HBeAg阴性 /
停药
Key words
chronic hepatitis B /
HBeAg negative /
drug withdrawal
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基金
北京市首都特色临床应用研究(Z181100001718033);艾滋病和病毒性肝炎等重大传染病防治(2018ZX10301-404);国家自然科学基金(NO.81803299);山东省自然科学基金(NO.ZR2019PH046)
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