Mức HBsAg và HBcrAg thấp ở cuối điều trị liên quan đến việc mất HBsAg sau khi ngừng điều trị nucleos(t)ide analog

BMC Gastroenterology - Tập 23 - Trang 1-11 - 2023
Yandi Xie1, Minghui Li2, Xiaojuan Ou3, Sujun Zheng4, Yinjie Gao5, Xiaoyuan Xu6, Ying Yang7, Anlin Ma8, Jia Li9, Yuemin Nan10, Huanwei Zheng11, Juan Liu12, Lai Wei13, Bo Feng1
1Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University People’s Hospital, Peking University Hepatology Institute, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing, China
2Department of Hepatology Division, Beijing Ditan Hospital, Capital Medical University, Beijing, China
3Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
4Complicated Liver Diseases and Artificial Liver Treatment and Training Center, Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment and Research, Beijing Youan Hospital, Capital Medical University, Beijing, China
5Department of Infectious Diseases, The Fifth Medical Center, General Hospital of PLA, Beijing, China
6Department of Infectious Diseases, Peking University First Hospital, Beijing, China
7Department of Infectious Diseases, The Second Hospital of Xingtai, Xingtai, China
8Department of Infectious Disease, Friendship Hospital, Beijing, China
9Department of Liver Disease, Tianjin Second People’s Hospital, Tianjin, China
10Department of Traditional and Western Medical Hepatology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
11Department of Liver Disease, Shijiazhuang Fifth Hospital, Shijiazhuang, China
12Research Center for Technologies in Nucleic Acid-Based Diagnostics, Changsha, China
13Department of Hepatopancreatobiliary Disease, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China

Tóm tắt

Việc mất kháng nguyên bề mặt viêm gan B (HBsAg) hiếm khi đạt được với liệu pháp nucleos(t)ide analog (NA), do đó hầu hết bệnh nhân cần điều trị NA suốt đời. Các nghiên cứu trước đây đã chỉ ra rằng một số bệnh nhân vẫn duy trì đáp ứng vi rút ngay cả sau khi ngừng NA. Tuy nhiên, vẫn còn tranh cãi xung quanh việc ngừng NA có làm tăng tỷ lệ mất HBsAg hay không. Do đó, nghiên cứu này nhằm đánh giá tỷ lệ tích lũy mất HBsAg và xác định các yếu tố dự đoán sự mất HBsAg sau khi ngừng NA. Nghiên cứu đa trung tâm này bao gồm các bệnh nhân dương tính với kháng nguyên e viêm gan B (HBeAg) không có xơ gan từ 12 bệnh viện ở Trung Quốc và đáp ứng các tiêu chí bao gồm. Các bệnh nhân được tuyển chọn đã ngừng NA và được theo dõi bằng đánh giá lâm sàng và xét nghiệm 3 tháng một lần trong vòng 24 tháng sau khi ngừng NA hoặc cho đến khi xảy ra tái phát lâm sàng (CR). Tổng cộng, 158 bệnh nhân được phân loại thành hai nhóm. Nhóm A bao gồm các bệnh nhân dương tính với HBsAg tại thời điểm ngừng NA (n = 139), và Nhóm B bao gồm các bệnh nhân âm tính với HBsAg tại thời điểm ngừng NA (n = 19). Trong Nhóm A, tỷ lệ tích lũy mất HBsAg ở 12 tháng và 24 tháng lần lượt là 4,3% và 9,4%. HBsAg ở cuối điều trị (EOT) (tỷ lệ nguy cơ (HR) = 0,152, P < 0,001) và kháng nguyên liên quan đến lõi viêm gan B ở cuối điều trị (HBcrAg) (HR = 0,257, P = 0,001) có liên quan đến việc mất HBsAg. Các diện tích dưới đường cong nhận diện đặc điểm cho các mức HBsAg và HBcrAg ở cuối điều trị lần lượt là 0,952 (P < 0,001) và 0,765 (P < 0,001). Những bệnh nhân có HBsAg ≤ 135 IU/mL (59,2% so với 1,3%, P < 0,001) hoặc HBcrAg ≤ 3,6 logU/mL (17% so với 5,4%, P = 0,027) có tỷ lệ mất HBsAg tích lũy cao hơn trong 24 tháng. Trong Nhóm B, không có bệnh nhân nào trải qua tái phát vi rút sau khi ngừng NA. Chỉ có 1 (5,3%) bệnh nhân có sự hồi phục HBsAg. HBsAg ≤ 135 IU/mL hoặc HBcrAg ≤ 3,6 logU/mL có thể được sử dụng để xác định bệnh nhân có khả năng cao hơn về mất HBsAg sau khi ngừng NA. Bệnh nhân âm tính với HBsAg sau khi ngừng NA có kết quả lâm sàng thuận lợi, và việc mất HBsAg là bền vững ở hầu hết các trường hợp.

Từ khóa

#HBsAg #HBcrAg #điều trị viêm gan B #nucleos(t)ide analog #mất HBsAg

Tài liệu tham khảo

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