慢性乙型肝炎治疗达标停药后复发与HBV-DNA载量关系

Relationship between HBV-DNA load and withdrawal relapse after achieving the therapeutic end-point criteria in chronic hepatitis B patients

目的探讨核苷(酸)类似物(nucleos(t)ide analogues,NA)治疗慢性乙型肝炎达标停药后复发率、复发时HBV-DNA水平与治疗前HBV-DNA水平的关系。方法接受并完成NA治疗和随访的慢性乙型肝炎患者69例,按治疗前HBV-DNA水平分为高复制组(HBV-DNA>1×105 copies/mL)28例,中复制组(HBV-DNA>1×104～1×105copies/mL)23例,低复制组(HBV-DNA<1×104 copies/mL)18例,比较3组NA停药后的复发率,分析停药复发HBV-DNA水平与治疗前水平间关系。结果停药随访期间30例患者复发,复发率43.47%,复发时间(20.83±14.39)周;高复制组复发率64.29%,中复制组34.78%,低复制组为22.22%,各组间比较差异均有统计学意义(P<0.05);NA治疗停药后3组复发者复发时HBV-DNA载量水平与治疗前比较差异均无统计学意义(P>0.05);治疗前HBV-DNA载量水平和复发时HBV-DNA载量水平呈正相关(r=0.80,P<0.05)。结论 NA治疗前HBV-DNA水平与停药后复发密切相关,HBV-DNA高复制者NA治疗时间需进一步延长。

Objective To explore the relationship of pretreatment HBV-DNA load level with withdrawal relapse rate and HBV-DNA level after reaching the cessation criteria in patients with chronic hepatitis B（CHB） treated with nucleos（t）ide analogues（NA）.Methods Sixty-nine patients were completed NA therapeutic courses and follow-up survey.According to the HBV-DNA duplication activity,these patients were divided into three groups,high duplication group（HBV-DNA1×105copies/mL,n=28）,middle duplication group（HBV-DNA1×104 to 1×105 copies/mL,n=23）,and low duplication group（HBV-DNA1×103 copies/mL,n=18）.The relapse rate was evaluated and compared in these three groups.The relationship between the relapse HBV-DNA level and the baselines was analyzed.Results Among the 69 patients,30 patients relapsed（43.47%） with the average relapse duration of（20.83±14.39） weeks after NA withdrawal.The relapse rates were 64.29%,34.78% and 22.22% in high,middle and low duplication groups respectively,which showed significant differences in these three groups（P0.05）.There were no significant differences in HBV-DNA load levels in all these groups at relapse compared with before treatment（P0.05）.The pretherapeutic HBV-DNA loads were positively correlated with the HBV-DNA loads at relapse（P0.05）.Conclusion The pretreatment HBV-DNA load level is closely correlated with the relapse,so the patients with active HBV duplication should receive a long-term NA antiviral therapy.