解放军医学杂志2025，Vol.50Issue(9)：1076-1082,7.DOI:10.11855/j.issn.0577-7402.0641.2025.0613
HBeAg阴性慢性乙型肝炎患者停用核苷(酸)类似物治疗后HBsAg、HBV DNA及ALT的变化特征分析
Characteristics of changes in HBsAg,HBV DNA and ALT after cessation of nucleos(t)ide analogue therapy in patients with HBeAg-negative chronic hepatitis B
摘要
Abstract
Objective To investigate the characteristics of changes in hepatitis B surface antigen(HBsAg),hepatitis B virus(HBV)deoxyribonucleic acid(DNA),and alanine aminotransferase(ALT)levels following the cessation of nucleos(t)ide analogues(NAs)therapy in hepatitis B e antigen(HBeAg)-negative chronic hepatitis B(CHB)patients with baseline HBsAg levels<1000 IU/ml.Methods This retrospective cohort study analyzed 73 HBeAg-negative CHB patients treated at the Fifth Medical Centre of Chinese PLA General Hospital from January 2020 to June 2023.Patients were divided into 3 groups according to baseline HBsAg level and discontinuation strategy:HBsAg-negative discontinuation group(n=14),HBsAg-positive discontinuation group(n=25),and HBsAg-positive continuation group(n=34).All patients were followed for 48 weeks.Baseline clinical characteristics and changes in virological and hepatic biochemical indicators during follow-up were compared among the 3 groups.Univariate logistic regression analysis was performed to assess the correlation between clinical indicators and HBV DNA reappearance in HBsAg-positive discontinuation group,and between clinical indicators and HBsAg decline>0.5 log IU/ml in this group.Results There were no significant differences in the baseline levels of gender,age,albumin,and total bilirubin among the 3 groups(P>0.05).The baseline direct bilirubin level was significantly higher in HBsAg-positive discontinuation group than that in other groups(P<0.05),while the lymphocyte counts were significantly higher in HBsAg-negative discontinuation group(P<0.05).During the 48-week follow-up period,the HBV DNA reappearance rate in HBsAg-positive discontinuation group(72.0%)was significantly higher than that in other groups(P<0.001).There was no significant difference in the incidence of ALT elevation among the three groups(P=0.260).The proportion of patients with HBsAg decline>0.5 log IU/ml in HBsAg-positive discontinuation group(24.0%)was significantly higher than that in HBsAg-positive continuation group(5.9%,P<0.05).The proportion of patients with HBsAg increase>0.5 log IU/ml in HBsAg-positive discontinuation group(12.0%)was also significantly higher than that in HBsAg-positive continuation group(0%,P<0.05).Univariate logistic regression analysis revealed no significant association between the analyzed clinical indicators and HBsAg decline(P>0.05).Conclusions Discontinuation of NAs therapy in HBsAg-negative patients demonstrates high safety,with sustained HBsAg negativity post-cessation and low risks of viral relapse and liver function abnormalities.For HBsAg-positive patients,discontinuation may promote HBsAg decline in some individuals but is associated with risks of HBV DNA reappearance and HBsAg elevation.The decision to discontinue therapy should be comprehensively evaluated based on patients'baseline HBsAg levels and clinical characteristics.关键词
慢性乙型肝炎/核苷(酸)类似物/停药/HBV表面抗原/HBV脱氧核糖核酸(DNA)复阳Key words
chronic hepatitis B/nucleos(t)ide analogues/drug discontinuation/hepatitis B surface antigen(HBsAg)/HBV deoxyribonucleic acid(DNA)reappearance分类
医药卫生引用本文复制引用
吕樵岚,刘丽,卿松,吉英杰,刘妍,张超,王福生,程勇前..HBeAg阴性慢性乙型肝炎患者停用核苷(酸)类似物治疗后HBsAg、HBV DNA及ALT的变化特征分析[J].解放军医学杂志,2025,50(9):1076-1082,7.基金项目
This work was supported by the National Key Research and Development Program of China(2023YFC2308104,2019YFC0840704),and the National Natural Science Foundation of China(82130019) 国家重点研发计划(2023YFC2308104,2019YFC0840704) （2023YFC2308104,2019YFC0840704）
国家自然科学基金重点项目(82130019) （82130019）
