Discussion On The Discontinuation Of The Treatment Of Nucleoside(Acid) Analogue Against Hepatitis B Virus Induces Acute-on-chronic Liver Failure

Purpose:Investigate the treatment of nucleoside(acid)analogues to hepatitis B virus is effective in the prevention of acute-on-chronic liver failure,and whether it is safe to discontinue nucleoside(acid)analogues against hepatitis B virus according to the guideline.and how can we prevent acute-on-chronic liver failure after nucleoside(acid)analogues discontinuance? Provide evidence for the clinical guidance of nucleoside(acid)analogues against hepatitis B virus treatment and prevention of acute-on-chronic liver failure.Method:This study retrospectively investigated all patients with hepatitis B-related acute-on-chronic liver failure treated in the Department of Infectious Diseases of the First Affiliated Hospital of Nanchang University between January 1,2013 and December 31,2016.According to the exclusion and inclusion criteria,a total of 848 patients with acute-on-chronic liver failure were collected,and clinical data and past medical history were collected to determine whether received nucleoside(acid)analogues against hepatitis B virus treatment in the past.and the patients received nucleoside(acid)analogues against hepatitis B virus treatment in the past recorded the treatment years,the time of stop the use of nucleoside(acid)analogues etc,and then analyzed the information.Results:1.From 2013 to 2016,there were a total of 848 patients of hepatitis B-related acute-on-chronic liver failure hospitalized in the First Affiliated Hospital of Nanchang University.The number of cases of hepatitis B-related acute-on-chronic liver failure has been increasing year by year.Among the collected cases,The number of patients who did not receive nucleoside(acid)analogues against hepatitis B virus in the past accounted for a relatively large proportion each year,accounting for 79.4% of the total.The proportion of patients caused by the discontiuance of nucleoside(acid)analogues against hepatitis B virus was about 16.4%.Acute-on-chronic liver failure occurred in patients who had been treated withnucleoside(acid)analogues,accounting for 4.2%.2.In the study of the causes of hepatitis B-ralated acute-on-chronic liver failure,the proportion of discontinue nucleoside(acid)analogues has increased year by year.Among them,there were 17 cases of discontinuation of nucleoside(acid)analogues in strict accordance with the guidelines in 4 years,in the discontinued nucleoside(acid)analogue accounted for 12.2%.3.Regardless of whether the discontinuation of nucleoside(acid)analogues against hepatitis B virus in accordance with the guidelines or self-discontinuation of nucleoside(acid)analogues against hepatitis B virus patients,the incidence of hepatitis B-related acute-on-chronic liver failure was focused on the time period within 18 months of the discontinuation of nucleoside(acid)analogues,most of which occurred within 6 months.4.There were no significant differences in the complications and exacerbation rates of patients with hepatitis B-related acute-on-chronic liver failure caused by discontinuation of nucleoside(acid)analogues in accordance with the guidelines and discontinuation of nucleoside(acid)analogues according to their own on the basis of non-cirrhosis.The complications and exacerbation rates of patients with hepatitis B-related acute-chronic liver failure caused by discontinuation of nucleoside(acid)analogues according to their own on the basis of cirrhosis were higher than the previous two categories.Conclusions:1.The treatment with nucleoside(acid)analogues against can reduce the incidence of hepatitis B-ralated acute-on-chronic liver failure,while the discontinuation of nucleoside(acid)analogues against hepatitis B virus can lead to acute-on-chronic liver failure and increases year by year.2.Whether the nucleoside(acid)analogues are discontinued according to the guidelines or the nucleoside(acid)analogues are discontinued according to their own,both may occur hepatitis B-related acute-on-chronic liver failure and both types increase year by year,most of which occur within 18 months.3.The risk of discontinuation of nucleoside(acid)analogues in patients with cirrhosis is high,and long-term nucleoside(acid)analogues should be treated againsthepatitis B virus.4.Nucleoside(acid)analogues can only inhibit the replication of hepatitis B virus and cannot be completely eliminated.Therefore,it is recommended to adhere to long-term nucleoside(acid)analogues against hepatitis B virus treatment and regularly test the antiviral efficacy.