编者按：第53届欧洲肝脏研究学会（EASL）年会召开期间，西班牙Vall d'Hebrón大学医院Maria BUTI教授出席“Meet the Experts: Hepatitis B: When to stop NUC therapy?”专题，与各国学者就乙型肝炎停药问题进行了探讨，并于会后接受了《国际肝病》记者的采访，相关内容整理如下。

 

是否有因素可预测停止核苷（酸）类似物治疗后的病毒学复发？

 

Buti教授：目前，还没有相关的临床因素可以明确判断哪些患者在停止核苷（酸）类似物（NUC）治疗后会出现病毒学复发。但从既往研究看，目前已知的最重要的临床因素是肝硬化，停用NUCs是肝硬化患者的禁忌。在非肝硬化患者中，我们可以停止NUC治疗，最相关的预测指标是HBsAg水平低。当然，这些患者在停止NUC治疗之前，需要达到两个标准，即ALT水平正常和HBV DNA检测不到

 

无肝硬化HBeAg阳性患者经NUC治疗发生HBeAg血清学转换后，您倾向于采取何种策略？

 

Buti教授：对于这类患者，有两种策略，一是巩固治疗一段时间后停用核苷（酸）类似物，另外一种是治疗至HBsAg清除。我更喜欢第一种方法。血清转换后，应在抗-HBe出现后进行一段时间的巩固治疗（通常为一年），然后停止治疗。对于第二种方法，我认为我们现在没有足够的证据表明继续使用NUC治疗会增加HBsAg清除。

 

对于预防停止NUC治疗后的病毒学复发，联合聚乙二醇干扰素和NUC的作用如何？

 

Buti教授：有一些研究正在探索这个方案，但结果是矛盾的。在我的临床实践中，我不使用这种方法，因为欧洲大多数患者不喜欢接受干扰素治疗。

 

是否有新的治疗处于临床评估，特别是有限疗程的治疗？

 

Buti教授：目前正在对一些新的治疗方法进行评估，尚处于早期探索阶段（第一阶段或第二阶段）。本届EASL年会上，我们了解到有关新的衣壳调节剂或免疫调节剂的最初几周治疗的新数据，似乎他们可以降低HBV DNA水平，但我们现在还没有足够的证据来说明这是否会改变现有的乙型肝炎治疗方案。我相信在下次会议中，我们将了解到这些新疗法的更多信息。

 

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Prof. Buti: There are no relevant clinical factors to differentiate those patients who are going to relapse after stopping NUCs. The most important clinical factor, however, is cirrhosis. Stopping NUCs in contraindicated in patients with liver cirrhosis. In non-cirrhotic patients, we can stop NUCs, and the most relevant indicator for that is a low level of HBsAg. Of course, these patients need to have normal ALT levels and undetectable HBV DNA. They have to meet these two criteria before stopping NUC therapy.

 

Prof. Buti: I prefer the first approach. After seroconversion, there should be a period of consolidation (usually one year) following anti-HBe emergence, and then stop therapy. For the second approach, I don’t think we have enough information right now that continuing with NUCs will increase HBsAg loss.

 

Prof. Buti: There are some studies looking at this option, but the results are contradictory. In my clinical practice, I don’t use this approach because the majority of patients in Europe don’t like to receive interferon therapy.

 

Prof. Buti: There are new therapies currently under evaluation. These therapies are in the early stage of development in phase I or phase II. At this meeting, we have heard new information about the first few weeks of treatment with the new capsid modulators or immune modulators. It seems that they will decrease levels of HBV DNA, but we don’t have enough information now to say if this will change the treatment scenario for hepatitis B. I am sure that at the next meeting we will have learned more information about these new treatments.