大多數(shù)肝病協(xié)會(huì)指南建議，失代償期肝硬化慢性乙肝患者通常應(yīng)該長(zhǎng)期使用核苷（酸）類似物（NA）**。然而，沒有試驗(yàn)據(jù)支持這一建議。第64屆肝病研究學(xué)會(huì)（AASLD）年會(huì)公布了一項(xiàng)研究，旨在評(píng)估早期應(yīng)用拉米夫定**組停止NA**的預(yù)后。
研究設(shè)計(jì)
這項(xiàng)研究包括失代償期慢性乙肝280例，其中男性228例，肝硬化115例，使用拉米夫定100 mg/day **1-50個(gè)月，停止**后進(jìn)行至少12個(gè)月的隨訪。隨訪期間對(duì)患者進(jìn)行監(jiān)測(cè)，前6個(gè)月監(jiān)測(cè)1-3次，之后每3-6個(gè)月監(jiān)測(cè)1次。采用Kaplan-Meier估計(jì)比較肝硬化和非肝硬化患者的非**事件（包括肝功能失代償（DE），肝細(xì)胞癌（HCC）和死亡）發(fā)生率。
研究結(jié)果
停止**后隨訪12-180個(gè)月（中位數(shù)：89.1），24.64％的患者發(fā)生非**事件，包括55例DE（16％），18例肝癌（6.4％）和3例死亡（1.1％）。肝硬化患者的DE，肝癌和死亡發(fā)生率仍然很低，但明顯高于非肝硬化患者。
結(jié)論
這項(xiàng)回顧性研究表明，大多數(shù)NA**成功的患者可以停止NA**，甚至肝硬化患者也是的，但停止**后必須嚴(yán)格進(jìn)行隨訪和監(jiān)測(cè)。
原文摘要
Background/Aims : Guidelines of major liver associations recommend that nucleot(s)ide analogue (NA) therapy should usually be continued indefinitely in chronic hepatitis B patients with decompensated cirrhosis. However, there is no eviden to support this recommendation. We therefore examined this issue using an earlier lamivduine treated cohort to study the outcomes of stopping NA therapy.
Methods : The study patients included 280 patients with decompensated chronic hepatitis B (228 males; 115 cirrhosis) who were treated with lamivudine 100mg/day for 1-50 months and were followed-up after ssation of therapy for at least 12 months. Their baseline features are listed in Table. After stopping therapy, they were monitored every 1-3 in the first 6 months and then every 3-6 months. The inciden of off-therapy events including hepatic decompensation (DE), hepatollular carcinoma (HCC) and mortality were compared between cirrhotic and non-cirrhotic patients using Kaplan-Meier estimates.
Results : Events occurred in 24.64 % of the patients during a follow-up period of 12-180 (median:89.1) months after stopping therapy, including 55 DE (16%), 18 HCC (6.4 %) and 3 mortalities (1.1 %). The inciden of DE, HCC and mortality remained low in cirrhotic patients though significantly higher than that of non-cirrhotic counterparts (Table).
Conclusion : The results of this retrospective study show that NA can be stopped safely in the majority of patients who were sucssfully rescued by NA therapy, even in cirrhotic patients. Proper off therapy monitoring is mandatory.