低龄期慢乙肝儿童临床治愈率超60%！起步抗病毒治疗越早、疗效越好-天涯论坛 - Powered by Discuz! Archiver

论坛 › 澳门 › 低龄期慢乙肝儿童临床治愈率超60%！起步抗病毒治疗越早、疗效越好

219mze 发表于 2024-6-20 20:44:50

低龄期慢乙肝儿童临床治愈率超60%！起步抗病毒治疗越早、疗效越好

<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q4.itc.cn/q_70/images03/20240322/dbfd83211d7a4e5ebbc15dbd0f526143.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">关注<span style="color: black;">咱们</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">编者按</span></span></strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">日前</span>，慢性乙型肝炎（chronic hepatitis B，CHB）儿童的抗病毒治疗已<span style="color: black;">作为</span>临床热点问题，多项<span style="color: black;">科研</span>证实HBeAg阳性的CHB儿童接受基于干扰素-α（IFN-α）和核苷（酸）类似物（NAs）的抗病毒治疗安全、有效，<span style="color: black;">起步</span>抗病毒治疗的年龄越小，临床治愈率越高，<span style="color: black;">更加多</span>临床<span style="color: black;">科研</span>证据仍在<span style="color: black;">持续</span>更新中。</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">近期，国家感染性<span style="color: black;">疾患</span>临床<span style="color: black;">科研</span>中心<span style="color: black;">专家</span>、解放军总医院第五医学中心感<span style="color: black;">患病</span>医学部<span style="color: black;">专家</span></span></span><strong style="color: blue;"><span style="color: black;"><span style="color: black;">王福生院士</span></span></strong><span style="color: black;"><span style="color: black;">和解放军总医院第五医学中心肝病医学部三病区<span style="color: black;">专家</span></span></span><strong style="color: blue;"><span style="color: black;"><span style="color: black;">张敏教授</span></span></strong><span style="color: black;"><span style="color: black;">合作<span style="color: black;">发布</span><span style="color: black;">科研</span>，结果<span style="color: black;">显示</span></span></span><strong style="color: blue;"><span style="color: black;"><span style="color: black;">HBeAg阳性的CHB儿童接受抗病毒治疗安全有效，部分患儿可实现临床治愈，其中1至<7岁患儿后HBsAg转阴率为50.78%，尤其是1至<3岁患儿HBsAg转阴率高达62.61%。<span style="color: black;">起步</span>抗病毒治疗的年龄和血清HBsAg定量水平是HBsAg转阴的独立影响<span style="color: black;">原因</span></span></span></strong></span></span><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"></span></span></span></span><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">。</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q8.itc.cn/q_70/images03/20240322/9b828fb7daff4f348f0009c00b9c20ae.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q7.itc.cn/q_70/images03/20240322/cce2f2b5bd0043ba9e68ba541f97572d.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;"><span style="color: black;">科研</span><span style="color: black;">办法</span>和样本信息</span></span></strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q6.itc.cn/q_70/images03/20240322/1d557755495143cd89dd86ba3d797e00.gif" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">回顾性纳入2014年6月至2021年9月在解放军总医院第五医学中心就诊的372例HBeAg阳性的CHB儿童。</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">入组标准如下：①年龄1至≤16岁；②血清HBsAg阳性≥6个月；③血清HBeAg阳性且HBeAb阴性；④血清HBV DNA> 2×10</span></span></span></span><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">4</span></span></span></span><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">IU/mL；⑤ALT≥40U/L；⑥肝活检或<span style="color: black;">没</span>创<span style="color: black;">检测</span>结果<span style="color: black;">表示</span>慢性肝炎伴中度或重度坏死炎症，伴或不伴纤维化。</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">排除标准：①失代偿性肝硬化；②前期已接受抗病毒治疗；③合并感染甲、丙、丁、戊型肝炎病毒、EB病毒、巨细胞病毒或人体免疫缺陷病毒；④合并其他肝病，如<span style="color: black;">自己</span>免疫性肝炎、<span style="color: black;">药品</span>性肝<span style="color: black;">损害</span>或Wilson’s<span style="color: black;">疾患</span>；⑤肝移植患儿；⑥肝癌；⑦合并甲状腺<span style="color: black;">疾患</span>等；⑧失访或中止治疗者。</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">所有纳入患儿按年龄分为1至<7岁（A组，256例）和≥7至16岁（B组，116例）两组，均接受24～36个月的抗病毒治疗且均随访至36个月，治疗<span style="color: black;">方法</span><span style="color: black;">包含</span>IFN-α单药、NAs单药以及IFN-α联合NAs用药。<span style="color: black;">重点</span>疗效<span style="color: black;">评估</span>指标是36个月时HBsAg转阴率。</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">为避免偏倚，对两组患儿的性别、血清HBsAg水平、ALT水平、肝穿病理结果等进行倾向性得分匹配（PSM-A组和PSM-B组，均79例），进一步分析<span style="color: black;">发掘</span>1至<7岁年龄组患儿抗病毒治疗应答率均优于≥7至16岁组。</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q4.itc.cn/q_70/images03/20240322/b98b39eed8714b1cb6b9dffae2840493.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;"><span style="color: black;">科研</span>结果</span></span></strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q7.itc.cn/q_70/images03/20240322/1f5a4fa9b65e43c58c6f0e16b3f1c83b.gif" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">01</span></span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">HBeAg阳性CHB儿童抗病毒治疗后可实现临床治愈，1至<7岁患儿的HBsAg转阴率更高。</span></span></strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">对两组患儿抗病毒治疗疗效分析<span style="color: black;">表示</span>，抗病毒治疗后1至<7岁（A组）患儿累积HBsAg转阴率（图1）<span style="color: black;">明显</span>高于≥7至16岁患儿（B组），两组之间统计学差异<span style="color: black;">明显</span>，<span style="color: black;">另外</span>，PSM匹配后队列分析<span style="color: black;">亦</span>得到类似<span style="color: black;">发掘</span>。</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q4.itc.cn/q_70/images03/20240322/bb4ece59c19b411f82f1a8fb6009cb59.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">图1. A组（1至<7岁）与B组（≥7至16岁）患儿在抗病毒治疗过程中的累积HBsAg转阴率</span></span></span></span><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"></span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">02</span></span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;"><span style="color: black;">起步</span>抗病毒治疗的年龄和基线血清HBsAg水平是治疗后HBsAg转阴的独立预测<span style="color: black;">原因</span>。</span></span></strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">单<span style="color: black;">原因</span>和多<span style="color: black;">原因</span>logistic回归分析<span style="color: black;">表示</span>，<span style="color: black;">起步</span>抗病毒治疗时的年龄和血清HBsAg水平是治疗后HBsAg转阴的独立预测<span style="color: black;">原因</span>。对年龄进行进一步分层分析（图2），结果<span style="color: black;">表示</span>1至<3岁的患儿疗效<span style="color: black;">明显</span>优于其他年龄组，提示<span style="color: black;">起步</span>治疗年龄越小、临床治愈率越高。</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q8.itc.cn/q_70/images03/20240322/60613bf4a4074699a253faa67e483fdd.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">图2. 372例HBeAg阳性CHB儿童在抗病毒治疗后36个月时的HBsAg转阴率</span></span></span></span><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"></span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">分组分析不同基线血清HBsAg定量水平患儿的临床<span style="color: black;">结果</span>（图3），纳入的372例患儿中，322例患儿有基线HBsAg定量检测值。以基线HBsAg定量水平1500 IU/mL为分界值将患儿分为两组，依次为基线HBsAg<1500 IU/mL（n=36）以及基线HBsAg≥1500 IU/mL（n=286），抗病毒治疗36个月后，两组患儿累积HBsAg转阴率分别为58.3%和38.1%（</span></span></span><span style="color: black;"><span style="color: black;"><span style="color: black;">P</span></span></span><span style="color: black;"><span style="color: black;"><span style="color: black;">=0.0021）。</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">图3. 不同基线血清HBsAg定量水平患儿抗病毒治疗后累积HBsAg转阴率</span></span></span></span><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"></span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q5.itc.cn/q_70/images03/20240322/3a9f321e327747a7986276a044215461.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">结论</span></span></strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q1.itc.cn/q_70/images03/20240322/cce5e11ee0084ddba7acfbf1195b4be5.gif" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">本<span style="color: black;">科研</span>结果<span style="color: black;">显示</span>，与年龄≥7岁接受抗病毒治疗的HBeAg阳性CHB儿童相比，1至<7岁患儿接受抗病毒治疗<span style="color: black;">能够</span><span style="color: black;">得到</span>更高的临床治愈率。该<span style="color: black;">科研</span>数据支持CHB儿童<span style="color: black;">初期</span>接受抗病毒治疗。<span style="color: black;">将来</span>仍需在前瞻性、多中心、大样本、随机对照<span style="color: black;">实验</span>中进一步证实，为儿童CHB<span style="color: black;">初期</span>抗病毒治疗<span style="color: black;">供给</span><span style="color: black;">更加多</span>的数据支持。</span></span></strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">参考文献：</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;"> Zhang M, Li J, Xu Z, et al. Functional cure is associated with younger age in children undergoing antiviral treatment for active chronic hepatitis B. Hepatol Int. 2024 Feb 20. doi: 10.1007/s12072-023-10631-9.</span></span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">源自</span>：《国际肝病》编辑部</span></span></span><a style="color: black;"><span style="color: black;">返回<span style="color: black;">外链论坛：http://www.fok120.com/</span>，查看<span style="color: black;">更加多</span></span></a></p>

<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">责任编辑：网友投稿</span></p>

JameBond 发表于 2024-9-25 09:42:54

对于这个问题，我有不同的看法...

7wu1wm0 发表于 2024-10-20 10:11:32

谷歌网站排名优化 http://www.fok120.com/

页: [1]

查看完整版本: 低龄期慢乙肝儿童临床治愈率超60%！起步抗病毒治疗越早、疗效越好