NAs治疗慢性乙型肝炎后HBsAg变化的特点和影响因素分析

目的观察慢性乙型病毒性肝炎（CHB）病人接受核苷（酸）类似物（NAs）治疗HBV DNA阴转后血清HBsAg定量的动态变化，对HBeAg阳性和HBeAg阴性组病人HBsAg定量的变化进行比较，推算HBsAg清除所需时间，探讨NAs药物治疗CHB的可能疗程。方法以NAs治疗HBV DNA阴转时HBsAg定量为基线值，观察6个月、1年、3年、5年、7年的HBsAg水平的动态变化，并比较HBeAg阳性组及HBeAg阴性组HBsAg定量之间的差异。结果109例HBeAg阳性病人，HBV DNA阴转时及6个月、1年、3年、5年、7年后HBsAg平均水平分别为3.347、3.329、3.107、3.169、2.960、2.164 log₁₀IU/mL；116例HBeAg阴性病人，HBsAg平均水平分别为3.133、3.193、2.970、2.967、2.536、2.083 log₁₀IU/mL。经NAs治疗，HBeAg阳性病人和HBeAg阴性病人HBV DNA阴转后、6个月、1年、3年、5年、7年HBsAg水平呈波动性下降趋势（P < 0.01）。根据HBsAg定量的下降趋势拟合的线性回归方程，推算HBeAg阳性组和HBeAg阴性组的HBsAg清除时间分别为25年和22年。结论NAs治疗的CHB病人，理论上推测HBeAg阳性组和HBeAg阴性组HBsAg的清除均需20年以上的时间，采用NAs治疗CHB需要较长的疗程。

Analysis of the characteristics and influencing factors of HBsAg change in chronic hepatitis B patients treated with NAs

ObjectiveTo observe the dynamic change of HBsAg serum level in chronic hepatitis B(CHB) patients treated with NAs for HBVDNA negative conversion, compare the change of HBsAg between HBeAg-positive and HBeAg-negative patients, estimate the time of HBsAg clearance, and explore the possible course of CHB treated with NAs.MethodsThe quantitation of HBsAg in patients treated with NA HBVDNA negative conversion was set as the baseline value, the dynamic change of HBsAg levels were observed after 6 months, 1 year, 3 years, 5 years and 7 years of HBVDNA negative conversion, and the difference of HBsAg quantification between HBeAg(+) group and HBeAg(-) group was compared.ResultsAmong 109 HBeAg-positive patients, the mean levels of HBsAg after 6 months, 1 year, 3 years, 5 years and 7 years of HBVDNA negative conversion were 3.347, 3.329, 3.107, 3.169, 2.960 and 2.164 log₁₀IU/mL, respectively.Among 116 HBeAg-negative patients, the mean levels of HBsAg after 6 months, 1 year, 3 years, 5 years and 7 years of HBVDNA negative conversion were 3.133, 3.193, 2.970, 2.967, 2.536 and 2.083 log₁₀IU/mL, respectively.After NAs treatment, the HBsAg levels in HBeAg-positive and HBeAg-negative patients showed a decreasing trend of fluctuation at 6 months, 1 year, 3 years, 5 years and 7 years after HBVDNA negative conversion(P < 0.01).According to the linear regression equation fitted by the quantitative decline trend of HBsAg, the HBsAg clearance time in HBeAg positive group and HBeAg negative group were calculated to be 25 years and 22 years, respectively.ConclusionsAmong the CHB treated with NAs, the clearance time of HBsAg in HBeAg positive group and HBeAg negative group will take more than 20 years in theory.Therefore, the treatment of CHB with NAs requires a long course of treatment.