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目的探讨核苷(酸)类似物(NUCs)治疗慢性乙型肝炎(CHB)停药后复发与停药时血清HBs Ag的量、HBVDNA水平的相关性。方法选取205例2010年1月至2014年6月在济宁市传染病医院门诊给NUCs治疗达到《慢性乙型肝炎防治指南》制订的停药标准计划停药的CHB患者为研究对象,停药时对其进行HBV M定量、高灵敏度HBV DNA定量检测。停药后随访1年,HBV DNA>103IU/m L定义为复发。结果在1年时CHB总的复发率65.9%(135/205)。HBs Ag定量≤100 m IU/m L组,复发率仅23.9%(11/46),HBs Ag定量>100 m IU/m L组,复发率78.0%(124/159),两组之间复发率差异有统计学意义(χ2=46.4,P<0.005)。HBV DNA定量≤20 IU/m L组,复发率56.4%(62/110),HBV DNA定量>20 IU/m L组,复发率76.8%(73/95),两组之间复发率差异有统计学意义(χ2=9.5,P<0.01)。同时符合HBs Ag定量≤100IU/m L、HBV DNA定量≤20 IU/m L组,复发率14.3%(5/35),其余病例复发率76.5%(130/170),两组之间复发率差异有统计学意义(χ2=49.9,P<0.005)。结论 NUCs治疗CHB停药后的复发与停药时HBs Ag的量、HBV DNA水平有一定相关性,HBs Ag定量≤100 m IU/m L和或HBV DNA定量≤20 IU/m L作为NUCs抗乙型肝炎病毒治疗停药指标,以达到最大的安全停药。
Objective To investigate the relationship between the serum levels of HBsAg and the level of HBVDNA after nucleos (s) acid analogue (NUCs) treatment for relapse and withdrawal of chronic hepatitis B (CHB). Methods From January 2010 to June 2014, 205 cases of CHB patients whose NUCs treatment met the withdrawal criteria prescribed in Guideline for Prevention and Treatment of Chronic Hepatitis B from January 2010 to June 2014 were selected as study subjects. Its quantitative HBV M, high-sensitivity HBV DNA quantitative detection. Followed up for 1 year after discontinuation of HBV DNA> 103IU / m L was defined as recurrence. Results At 1 year, the overall recurrence rate of CHB was 65.9% (135/205). The recurrence rate was only 23.9% (11/46) with HBsAg quantification ≤ 100 m IU / m L group, and the recurrence rate was 78.0% (124/159) with HBsAg quantification> 100 m IU / m L group. Rate difference was statistically significant (χ2 = 46.4, P <0.005). The recurrence rate was 56.4% (62/110) in HBV DNA ≤20 IU / m L group and HBV DNA was> 20 IU / m L group, the recurrence rate was 76.8% (73/95) Statistical significance (χ2 = 9.5, P <0.01). At the same time, it was consistent with the HBsAg quantification ≤100IU / m L, HBV DNA quantitation ≤20IU / m L group, the recurrence rate was 14.3% (5/35), and the recurrence rate was 76.5% (130/170) in other cases. The recurrence rate The difference was statistically significant (χ2 = 49.9, P <0.005). Conclusion The relapse after discontinuation of CHB by NUCs is related to the amount of HBsAg and the level of HBV DNA when stopping the treatment. The quantification of HBsAg is less than or equal to 100 mIU / m L and HBV DNA is less than or equal to 20 IU / m L as the NUCs Hepatitis B virus treatment withdrawal index, in order to achieve the maximum safe withdrawal.