The research team of the First Affiliated Hospital of Guangxi Medical University professor Jiang Jianning, reported their application of nuc
The research team of the First Affiliated Hospital of Guangxi Medical University professor Jiang Jianning, reported their application of nucleoside (acid) drugs (NA) cohort study results of long-term follow-up treatment of big three chronic hepatitis B after discontinuation of: to reach the standard of drug withdrawal in 81 cases of patients were treated with NA, including 36 cases (44.4%) of patients with recurrence within 1 years, most of the recurrence occurred during the withdrawal within 6 months. Thus, the patients with HBeAg positive hepatitis even stopping, still have a relatively high recurrence rate! How can we try to reduce the recurrence rate after stopping drug?
Inspired by the above results, I believe that from the following seven aspects (family history, drug history, early treatment response, consolidate treatment time and withdrawal age, HBsAg level, liver histology) with lower recurrence rate:
The results of this study indicated that the relapse rates of lamivudine resistant group and lamivudine group were 78.6% and 37.3%, respectively. Lamivudine resistance rate, the initial selection of nucleoside (acid) treatment, to avoid long-term treatment, use drug resistance once Ramiv orders, not only caused difficulties in the follow-up treatment, but also for the future high recurrence after discontinuation rate undoing.
Two, the treatment of 3 months can be detected and can not detect the recurrence rate of HBVDNA patients were 64.3% and 34%. Thus, as far as possible in a short period of time to make the patient's HBVDNA quantitative reach the level of measurement, not only can significantly reduce the drug resistance rate, and can greatly reduce the recurrence rate. How to in a short period of time to reach the amount of virus negative? The first step is to choose the appropriate treatment time, the appropriate timing of treatment, patients should be clear when the most intense immune reaction, usually with ALT increased significantly as a symbol; secondly to try to choose a strong low resistant antiviral monotherapy or combination, such as entecavir 1 mg / day, or telbivudine combined with adefovir dipivoxil etc., consolidation treatment for three months after HBVDNA turned negative, then returned to the conventional dose of entecavir 0.5 mg / day.
Three, liver histology index was also associated with relapse rate after stopping drug. The recurrence rate was higher in patients with high liver histological activity index score and fibrosis score. We thus obtained is inspired: antiviral treatment is the key, but not the only reasonable, combined with anti-inflammatory hepatoprotective, anti fibrosis and immune regulation preparation, can maximize the improvement in patients with hepatitis B liver inflammation and necrosis and fibrosis, can reduce the recurrence rate.
Four. The recurrence rate of 3log10 in patients with HBsAg IU/ml and withdrawal of 2log10 IU/ml in one year after the withdrawal of the drug was and 9%, respectively. The level of HBsAg was positively correlated with the HBVcccDNA in the liver nuclei, and how to effectively reduce the level of HBsAg in order to achieve the purpose of reducing the recurrence rate, which is of great interest to the liver disease department.
Five. The results showed that the recurrence rate was significantly lower than that of the patients who had been treated for more than 24 months after HBeAg seroconversion and less than those of the patients who had been treated for less than 24 months. Appropriate to extend the consolidation of treatment time, can reduce the recurrence, which is the consensus of the national guidelines, how long it is appropriate to consolidate the time, 2 years, 3 years, or 4 years? More clinical studies are needed to answer.
Six, a foreign study shows that when the withdrawal of the age is also one of the factors affecting recurrence. The cumulative recurrence rate was 9.1%, 22.5%, 63.5%, and five years after discontinuation of drug withdrawal in patients younger than age, 20--30 years, 30--40 years and older than the age of 40 years. For young patients with hepatitis B, if the failure of interferon therapy or interferon treatment contraindications, should be decisive use of nucleoside (acid) treatment, the sooner reached HBeAg seroconversion, recurrence rate is low.
Seven, the recurrence rate of patients with family history of hepatitis B, family history and family history of hepatitis B were 64.5%, 43.3% and 15%, respectively. Thus, there is a family history of hepatitis B, we must try to consolidate the extension of treatment time, the best in 3 years, or even longer, try to stop at the HBsAg level is low, can reduce the high recurrence rate after stopping drug.