大多数肝病协会指南建议，失代偿期肝硬化慢性乙肝患者通常应该长期使用核苷（酸）类似物（NA）治疗。第64届美国肝病研究学会（AASLD）年会公布了一项研究，旨在评估早期应用拉米夫定治疗组停止NA治疗的预后。

研究设计

这项研究包括失代偿期慢性乙肝280例，其中男性228例，肝硬化115例，使用拉米夫定100 mg/day 治疗1-50个月，停止治疗后进行至少12个月的随访。随访期间对患者进行监测，前6个月监测1-3次，之后每3-6个月监测1次。采用Kaplan-Meier估计比较肝硬化和非肝硬化患者的非治疗事件（包括肝功能失代偿（DE），肝细胞癌（HCC）和死亡）发生率。 

研究结果

停止治疗后随访12-180个月（中位数：89.1），24.64％的患者发生非治疗事件，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，肝癌和死亡发生率仍然很低，但明显高于非肝硬化患者。 

结论

这项回顾性研究表明，大多数NA治疗成功的患者可以安全停止NA治疗，甚至肝硬化患者也是安全的，但停止治疗后必须严格进行随访和监测。

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 evidence 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 cessation 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 incidence of off-therapy events including hepatic decompensation (DE), hepatocellular 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 incidence 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 successfully rescued by NA therapy, even in cirrhotic patients. Proper off therapy monitoring is mandatory.

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