慢性HBV感染者经核苷(酸)类似物治疗获血清HBsAg转阴后的长期预后

Long-Term Clinical Prognosis of CHB Patients with HBsAg Seroclearance after Long-Term Nucleos(t)ide Analogues Antiviral Therapy

【目的】回顾性研究长期服用核苷(酸)类似物的慢性乙型肝炎病毒(CHB)患者获得血清HBsAg转阴后的长期临床预后。【方法】选取中山大学附属第三医院长期服用核苷(酸)类似物抗病毒治疗获得血清HB?sAg转阴的127例慢乙肝患者为研究对象,失访患者23例,纳入本研究的患者104例。定期收集患者临床数据,包括患者人口学数据、家族史、个人病史、基线及随访各时间点的生化学、病毒学、血清学、肝脾影像学指标以及药物治疗安全性数据等。【结果】104例患者中,85.6%(89例)男性,37.7%(34例)基线时HBeAg阳性;经过平均5.5(0.3～14.0)年核苷(酸)类似物治疗,HBsAg阴转时平均年龄为49.0(27.0～81.0)岁,ALT复常率为66.2%(48/68),HBV DNA不可测率为98.1%(102例),HBeAg转阴率为85.3%(29/34),HBeAg/HBeAb转换率为79.4%(27/34),HBsAg阴转率为100%(104例),HBsAg/HBsAb转换率7.7%(8例)。104例患者至最后1次随访时,ALT复常率为83.8%(57/68),HBV DNA不可测率为99.1%(103),HBeAg阴转率为88.2%(30/34),HBeAg/HBeAb转换率为79.4%(27/34),HBsAg阴转率为97.1%(101),HBsAg/HBsAb转换率为27.9%(29例),3例患者出现HBsAg复转阳,但血清HBsAg滴度较低,HBsAg滴度对数值波动在-0.3～0.7 U/mL。1例(1.0%)患者从慢性乙型肝炎进展至肝硬化,2例(1.9%)肝硬化患者进展至肝癌,无1例患者死亡。【结论】服用核苷(酸)类似物抗病毒治疗的慢性HBV感染者获得血清HBsAg转阴后的长期临床预后良好。

【Objective】Retrospective study on the clinical characteristics and the long-term clinical outcome of regulatory follow-up chronic HBV infection patients achieving HBsAg seroclearance after long-term nucleos(t)ide analogues(NA)treatment.【Methods】127 chronic hepatitis B infection patients with HBsAg seroclearance after NA long-term treatment were selected as the study subjects,23 patients loss of follow-up,and 104 patients were enrolled in the study.Routinely collected clinical data of the 104 patients with HBsAg seroclearance,including patient demographic data,family history,personal history,baseline and follow-up at each time point of biochemical,virological,serological response data,liver and spleen imaging indexes and drug safety during the treatment.Primary end point:HBsAg seroclearance rate(semi quantitative method:HBsAg titer<1.0 COI;quantitative method:HBsAg titer<0.05 U/mL).【Results】In these patients who achieved serum HBsAg negative,86.6%(89 cases)were male,37.7%(34)were HBeAg positive at baseline.When HBsAg seroclearance after 5.5(0.3-14.0)years follow-up,the mean age was 49.0(27.0~81.0)years,ALT normalization was 66.2%(48/68)and HBV DNA undetectable rate was 98.1%(102/104),HBeAg seroclearance rate was 85.3%(29/34),HBeAg/HBeAb seroconversion rate was 79.4%(27/34),HBsAg/HBsAb seroconversion rate 7.7%(8/104).In the last follow-up,ALT normalization was 83.8%(57/68)and HBV DNA undetectable rate was 99.1%(103/104),HBeAg seroclearance rate was 88.2%(30/34),HBeAg/HBeAb seroconversion rate was 79.4%(27/34),HBsAg seroclearance rate was 97.1%(101/104),HBsAg/HBsAb seroconversion rate 27.9%(29/104).3 cases in patients HBsAg turned positive again,but the level of lg HBsAg were very low,ranged from-0.3 to 0.7 U/mL.3 patient developed disease progression to liver cirrhosis or liver cancer,and no one patient died.【Conclusion】The long-term clinical prognosis of CHB patients with HBsAg seroclearance after long-term NA antiviral therapy was favourable.