核苷(酸)类药物长期治疗HBeAg阳性慢性乙型肝炎患者血清HBsAg、HBeAg和HBV DNA动态变化及应答相关性

The dynamic changes of HBsAg,HBeAg and HBV DNA levels and their correlation with HBeAg seroconversion in HBeAg-positive chronic hepatitis B patients with long-term nucleos(t)ide analogues treatment

目的观察核苷(酸)类药物长期治疗的HBeAg阳性CHB患者基线HBsAg、HBeAg及HBV DNA定量水平在治疗过程中的动态变化,分析这些指标与HBeAg血清转换的相关性。方法回顾分析439例HBeAg阳性CHB患者治疗4年的临床随访资料。结果 HBeAg阳性CHB患者,基线HBsAg定量与HBeAg、HBV DNA呈正相关,HBeAg定量与HBV DNA定量呈较弱的正相关。经过4年抗病毒治疗,HBsAg、HBeAg、HBV DNA水平均有明显下降。治疗初始6个月HBsAg下降速率越高,基线HBsAg、HBeAg定量水平越低时越有可能达到HBeAg血清应答(SR)。HBeAg阳性CHB患者,经过4年抗病毒治疗,达到SR者138例,其中ETV组35例,LDT组75例,LDT+ADV组11例,ETV+ADV组9例,LAM+ADV组8例。结论抗病毒治疗初始6个月HBsAg下降速率越高,基线HBsAg、HBeAg定量水平越低时越有可能达到HBeAg血清学应答。

Objective To investigate the dynamic changes of hepatitis B surface antigen(HBsAg),hepatitis B e antigen(HBeAg)and hepatitis B virus(HBV)DNA in HBeAg-positive chronic hepatitis B(CHB)patients with long-term treatment of nucleos(t)ide analogues,and to analyze their correlations with HBeAg seroconversion.Methods Clinical data of 439 HBeAg-positive CHB patients with 4-year follow-up was retrospectively analyzed.Results At baseline,HBsAg was positively correlated with HBeAg and HBV DNA,and HBeAg was weakly positively correlated with HBV DNA in HBeAgpositive CHB patients.After 4-year antiviral therapy,levels of HBsAg,HBeAg and HBV DNA were significantly decreased.Higher HBsAg decline rate in the first 6 months and lower levels of HBsAg and HBeAg at baseline showed higher possibility of HBeAg serum response(SR)rate.Among the HBeAg-positive CHB patients,there were 31.44%acheiving HBeAg SR,including 28.65% with entecavir treatment,50.34% with telbivudine,48.39% with telbivudine+adefovir,9.09% with entecavir + adefovir and 10.13% with lamivudine + adefovir.Conclusion Patients with higher HBsAg decline rate in the initial 6 months of antiviral therapy,as well as lower levels of HBsAg and HBeAg at baseline,might have the higher possibility to acheive HBeAg SR.