- 期刊
Virological Response and Clinical Events in Patients with Chronic Hepatitis B Treated with Nucleotide Analogue
探討以口服核苷酸類似物治療慢性B型肝炎長期抑制病毒對病程發展之影響及不良臨床結果之因素分析
摘要
Objective: Nucleotide analogue (NUC) is a potent inhibitors of polymerase/ reverse transcriptase inhibitor of HBV replication. The aims of this study were to identify its effect on occurrence of clinical event (CE). Methods: Clinical events were defined as development of hepatocellular carcinoma (HCC), decompensation or death. 104 CHB patients treated with NUC were classified as chronic hepatitis, compensated cirrhosis and decompensated cirrhosis. We examined differences among groups on virological response (VR) and CE. Baseline factors associated with CE were explored. Results: Overall VR rate was 97.1%. Proportion of CE was 21.2%. We found no significant difference among groups on VR or CE and no significant correlation between VR and CE. A proportion of CE was significant higher among patients with decompensated cirrhosis. In Cox models, CTP classification, score and age were independent predictors for CE. Conclusions: Long-term NUC therapy does not eliminate CE risk. Beneficial effect was especially significant among patients with younger, inactive disease. It should remain under surveillance even virological remission.
並列摘要
目的：核苷酸類似物是一種反轉錄酶抑制劑，臨床上用於慢性B型肝炎治療。長期治療是否可以有效降低不良臨床結果發生，迄今仍未有定論。方法：不良臨床結果定義為治療後仍有肝細胞癌、肝功能失去代償、或者死亡。採回溯分析，自2010年1月至2014年12月，將本院登錄慢性B型肝炎治療計劃患者104例區分為三組，慢性肝炎無肝硬化者64例，代償性肝硬化者25例，失償性肝硬化者15例，以核苷酸類似物為第一線治療藥物，針對病毒反應率、不良臨床結果發生率比較其差異性，並探討發生不良臨床結果的預測因子。結果：總體病毒反應率97.1%，不良臨床結果發生率21.2%。三組不同嚴重程度肝功能之患者，在抑制病毒及不良臨床結果發生上，其臨床效果表現相當。不良臨床結果發生率不受病毒反應影響。不良臨床結果發生率在失償性肝硬化患者顯著性升高。Cox多變量迴歸分析顯示，年齡、Child分數、Child分類是發生不良臨床結果的預測因子。結論：以口服核苷酸類似物長期治療，無法預防不良結果發生。病患年齡較長或肝功能不佳者，縱使達到病毒反應，臨床上仍要密切監控。