慢性乙型肝炎患者核苷(酸)类似物停药后复发预测因素meta分析

摘要/Abstract

摘要： 目的探讨慢性乙型肝炎患者核苷(酸)类似物(NA)抗病毒治疗停药后复发的风险因素。方法检索Pubmed、Cochrane图书馆、EMBASE和CBM数据库,时间范围为从数据库成立至2018年3月。从符合要求的文献中提取数据。采用Review Manager软件(RevMan 5.3版)进行meta分析。结果纳入2002年至2018年期间共64项研究,分析了年龄、性别、HBV DNA水平和动态变化、HBsAg水平、药物选择、病毒学应答所需时间和总疗程等因素与病毒学复发之间的相关性。meta分析结果显示患者基线年龄每增加1岁,病毒学复发风险相对升高4%;达到完全病毒学应答所需时间每延长1个月,病毒学复发风险平均相对升高13%;停药时HBsAg水平每增加1 lg IU/mL,病毒学复发风险平均相对升高81%。值得关注的是HBcrAg、HBV RNA、抗HBc定量检测等新型标志物初步提示其在病毒学复发中的预测潜力。结论慢性乙型肝炎患者的年龄、病毒学应答所需抗病毒治疗的时间、停药时HBsAg水平与NA停药后病毒学复发风险相关。新型标志物HBcrAg、HBV RNA、抗HBc定量检测等需进一步扩大研究证实其在病毒学复发中的预测价值。

关键词: 慢性乙型肝炎;核苷(酸)类似物;病毒学复发;风险因素;meta分析

Abstract: Objective To investigate the risk factors for relapse after discontinuation of nucleos(t)ide analogues (NAs) in patients with chronic hepatitis B (CHB).Methods Electronic searches were conducted in PubMed, Cochrane Library, EMBASE and CBM before March 2018. A meta-analysis was performed based on the extracted data using Review Manager software (RevMan version 5.3). Results From 2002 to 2018, a total of 64 studies were included to investigate the correlation between candidate risk factors and virological relapse (VR). For each additional year of age, the risk of VR was relatively increased by 4%. For each additional month to complete virological response, the risk of VR was relatively increased by 13%. For each additional logarithmic level of hepatitis B surface antigen (HBsAg), the risk of VR was relatively increased by 81%. Interestingly, new markers such as Hepatitis B core-related antigen (HBcrAg), hepatitis B virus ribonucleic acid (HBV RNA) and quantitative detection of antibody to hepatitis B core antigen (anti-HBc) preliminarily indicated their predictive potential in VR. Conclusion The age of patients with chronic hepatitis B, the time required for virological response to antiviral treatment, and HBsAg level at the end of NAs treatment are positively correlated with VR. Predictive value for VR of new markers such as HBcrAg, HBV RNA and quantitative detection of anti-HBc remains to be further investigated and confirmed by extensive clinical studies.

Key words: Chronic hepatitis B, Nucleos(t)ide analogues, Virological relapse, Risk factor, meta-analysis

王艳, 姚甜甜, 钱建丹, 程浩, 王贵强. 慢性乙型肝炎患者核苷(酸)类似物停药后复发预测因素meta分析[J]. 肝脏, 2019, 24(7): 744-751.

WANG Yan, YAO Tian-tian, QIAN Jian-dan, CHENG Hao, WANG Gui-qiang.. Meta-analysis on risk factors for relapse after discontinuation of nucleos(t)ide analogues in patients with chronic hepatitis B[J]. Chinese Hepatolgy, 2019, 24(7): 744-751.

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