核苷(酸)类似物停药后对慢性乙型肝炎患者预后的影响

Effect on Prognosis of Chronic Hepatitis B Patients After Nucleoside(Acid)Analogue Withdrawal

目的:探讨核苷(酸)类似物(NAs)停药后对慢性乙型肝炎(CHB)患者乙型肝炎病毒脱氧核糖核酸(HBVDNA)转阳、丙氨酰氨基转移酶(ALT)复发的影响。方法:选取2015年6月-2019年6月中国人民解放军东部战区海军医院感染科门诊及住院的初次接受NAs治疗达到停药标准的CHB患者98例,接受治疗药物不同,分为拉米夫定(LAM)组(13例)、阿德福韦酯(ADV)组(21例)、恩替卡韦(ETV)组(64例)。观察停药48周时患者病毒学和生化学指标反弹情况。结果:98例CHB患者停药48周时,血清HBVDNA转阳率54.08%,血清ALT复发率44.90%;停药48周时,LAM组、ADV组、ETV组患者血清HBVDNA转阳发生率、血清ALT复发率比较,差异无统计学意义(P>0.05);停药48周时,乙型肝炎病毒e抗原(HBeAg)阳性患者与阴性患者的血清HBVDNA转阳发生率、血清ALT复发率比较,差异无统计学意义(P>0.05);停药48周时,HBVpgRNA阳性患者与HBVpgRNA阴性患者转阳发生率、血清ALT复发率比较,差异无统计学意义(P>0.05)。结论:接受NAs治疗达到停药标准的CHB患者,不管应用现有的何种药物,在停药后HBVDNA转阳、ALT复发率均较高。

Objective:To investigate the effect on hepatitis B virus RNA(HBV DNA)positive conversion and alanine aminotransferase(ALT)recurrence in patients with chronic hepatitis B(CHB)after nucleoside(acid)analogues(NAs)withdrawal.Methods:Ninety-eight CHB outpatients and inpatients who received initial treatment of NAs and met withdrawal criteria were selected from Department of Infections Disease,Eastern Theater Command Naval Hospital of Chinese PLA between June 2015 and June 2019.According to different treatment drugs,they were divided into lamivudine(LAM)group(13 cases),adefovir dipivoxil(ADV)group(21 cases),and entecavir(ETV)group(64 cases).The rebounds of the virological and biochemical indicators of patients were observed at 48 weeks after drug withdrawal.Results:Among the 98 CHB patients,the positive conversion rate of serum HBV DNA was 54.08%and serum ALT recurrence rate was 44.90%at 48 weeks after drug withdrawal.There was no statistically significant difference in the positive conversion rate of serum HBV DNA and serum ALT recurrence rate between LAM group,ADV group and ETV group at 48 weeks after drug withdrawal(P>0.05).There was no statistically significant difference in the positive conversion rate of serum HBV DNA and serum ALT recurrence rate between hepatitis B virus e antigen(HBeAg)positive patients and negative patients at 48 weeks after drug withdrawal(P>0.05).There was no statistically significant difference in the positive conversion rate of serum HBV DNA and serum ALT recurrence rate between HBV pgRNA positive patients and HBV pgRNA negative patients at 48 weeks after drug withdrawal(P>0.05).Conclusion:The CHB patients who receive NAs treatment and meet the withdrawal criteria still have high HBV DNA positive conversion rate and ALT recurrence rate after withdrawal,whatever currently available medicine is used.