核苷(酸)类似物治疗乙型肝炎肝硬化代偿期达到“功能性治愈”后停药的影响

Effect of NAs in the treatment of hepatitis B cirrhosis compensation period after aeaching"functional cure"

目的观察核苷(酸)类似物(NAs)治疗乙型肝炎肝硬化代偿期患者达到“功能性治愈”后停药的影响。方法回顾性收集2019年5月—2020年5月于荆州市第二人民医院行NAs治疗的乙型肝炎肝硬化代偿期患者95例,其中达到“功能性治愈”后停药患者40例作为停药组,继续用药患者55例作为继续用药组,对2组患者进行为期24个月的随访。比较2组达到“功能性治愈”与随访6、12、24个月的丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血清总胆红素(TBil)、HBV-DNA载量及抗-HBs、乙型肝炎E抗原(HBeAg)阳性率,比较2组患者复发率、原发性肝癌发生率及肝弹性超声值。结果达到“功能性治愈”时,2组患者ALT、AST、TBil水平与抗-HBs、HBeAg阳性率比较差异均无统计学意义(P>0.05)。随访6、12、24个月,2组患者ALT、AST、TBil水平与HBV-DNA载量及抗-HBs、HBeAg阳性率比较差异均无统计学意义(P>0.05)。随访24个月,2组复发率、原发性肝癌发生率、肝弹性超声值比较差异均无统计学意义(P>0.05)。结论乙型肝炎肝硬化代偿期患者达到“功能性治愈”后可考虑停止NAs的使用。

Objective To observe the effect of nucleoside(acid)analogues(NAs)in the treatment of hepatitis B cirrhosis compensation period after aeaching"functional cure".Methods Retrospective collection of 95 patients with hepatitis B cirrhosis compensation period after aeaching"functional cure"at the Second People′s Hospital of Jingzhou from May 2019 to May 2020.Among them,40 patients who stopped medication after reaching"functional cure"were selected as the discontinuation group,and 55 patients who continued medication were selected as the continued medication group.Two groups of patients were followed up for 24 months.The positive rates of alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum total bilirubin(TBil),HBV-DNA load,anti-HBs,and HBeAg in two groups were compared,which achieved"functional cure"and follow-up for 6,12,and 24 months.The recurrence rate,incidence of primary liver cancer,and liver elastic ultrasound values between the two groups were compared.Results When reaching"functional cure",there were no statistically significant difference in the levels of ALT,AST,TBil,and the positive rates of anti-HBs and HBeAg between the two groups of patients(P>0.05).During follow-up for 6,12,and 24 months,there were no statistically significant difference in the levels of ALT,AST,TBil,HBV-DNA load,anti-HBs,and HBeAg positivity rates between the two groups of patients(P>0.05).After follow-up of 24 months,there were no statistically significant difference in the recurrence rate,incidence of primary liver cancer,and liver elastic ultrasound values between the two groups(P>0.05).Conclusion Stop the use of NAs after achieving"functional cure".