摘要:
Objective To analyze antiviral nucleotide-induced dynamic change of HBsAg quantity over 3-year follow-up during the period of sustained viral response and the prognostic value of HBsAg level prior to drug-withdrawal for sustained viral response in patients with chronic hepatitis B negative for HBeAg.Methods 115 patients with chronic hepatitis B negative for HBeAg were treated with antiviral nucleotide.HBsAg quantity was measured every half year,and the dynamic change of 3-year was analyzed.35 patients withdrew nucleotide successively 3 years later,they were followed up 1 more year to observe the persistence of curative effect after drug-withdrawal.The relationship between HBsAg quantity at point of drug-withdrawal and the persistence of curative effect was analyzed.Results HBsAg quantity of 115 patients with chronic hepatitis B negative for HBeAg decreased gradually with the prolongation of antiviral therapy in 3-year follow-up period (F=3.01,P<0.05).HBsAg quantity at baseline was (3.13±0.79) logIU/ml,and those after 6,12,18,24,30,36 months were (3.11±0.86),(3.06±0.85),(2.98±0.92),(2.91±0.84),(2.83±0.82),(2.76±0.95) logIU/ml respectively (compared with the baseline,t =0.18,0.65,1.33,2.05,2.83,3.21,P=0.85,0.52,0.19,0.04,0.005,0.002).After drug-withdrawal,HBsAg quantity in the group of sustained off-treatment virological response (n=13) and the group of virological recurrence (n=22) were (2.21±0.73),(2.89±0.95) logIU/ml (t=2.03,P=0.03).Conclusions HBsAg quantity of patients with chronic hepatitis B negative for HBeAg decreased with prolongation of antiviral therapy.The patients who had lower HBsAg quantity at point of drug-withdrawal had better persistence of curative effect after drug-withdrawal.%目的 分析HBeAg阴性慢性乙型肝炎患者在应用核苷(酸)类抗病毒药物治疗3年期间HBsAg定量的动态变化以及其停药前水平对持续病毒学应答的预测作用.方法 115例HBeAg阴性慢性乙型肝炎患者应用核苷类药物抗病毒治疗,每隔半年检测HBsAg定量,分析3年HBsAg的动态变化.有35例患者3年后陆续停药,继续随访1年,观察停药后疗效持续性.分析停药患者停药时HBsAg定量与疗效持续性的关系.结果 115例HBeAg阴性患者随着使用核苷(酸)类抗病毒药物的治疗,HBsAg定量逐年有下降趋势且有统计学差异(F=3.01,P<0.05).HBsAg定量在基线为(3.13±0.79)logIU/ml,在治疗6、12、18、24、30、36个月分别为(3.11±0.86)、(3.06±0.85)、(2.98±0.92)、(2.91±0.84)、(2.83±0.82)、(2.76±0.95) logIU/ml(与基线比较,t值分别为0.18、0.65、1.33、2.05、2.83、3.21;P值分别为0.85、0.52、0.19、0.04、0.005、0.002).持续病毒学应答组(13例)与病毒学复发组(22例)在停药时HBsAg水平分别为(2.21±0.73)、(2.89±0.95)logIU/ml,两组病例的停药时HBsAg水平比较有统计学差异(t=2.03,P=0.03).结论 HBeAg阴性慢性乙型肝炎患者HBsAg定量均随着核苷(酸)类抗病毒药物治疗时间的延长而下降.停药患者停药时HBsAg定量低水平与更好的持续病毒学应答相关.