EASL 2018 SAT-231 抗病毒药物终末期肝病评分模型减少 治疗预测

StephenW

EASL 2018 SAT-231
Decreased model for end-stage liver disease score after antiviral
Treatment predicts reduced risk of mortality and hepatic events in
Chronic hepatitis B related cirrhosis – a study of 1927
L.-H. Grace Wong1, T.C. Yip2, H. Chan3, Y.-K. Tse4, W. Sun, V. Wong1.
1The Chinese University of Hong Kong, Dept of Medicine and
Therapeutics, Hong Kong, Hong Kong; 2The Chinese University of Hong
Kong, Room 94020D, 7/F, Lui Che Woo Clinical Sciences Building, Hong
Kong; 3The Chinese University of Hong Kong, Hong Kong, Hong Kong,
Hong Kong; 4The Chinese University of Hong Kong, Room 94020D, 7/F,
Lui Che Woo Clinical Sciences Building, Hong Kong, Hong Kong
Email: [email protected]
Background and Aims: The Model for End-Stage Liver Disease
(MELD) is a scoring system for assessing the severity of chronic liver
Disease and to prioritize patients with liver cirrhosis for liver
Transplantation. Yet there has been scanty data on
In MELD score after antiviral treatment leads to improvement in
Clinical outcome and reduced hepatic events.We are aimed to study the
Impact of baseline and on-treatment MELD score in patients with
Chronic hepatitis B (CHB) related cirrhosis.
Method: CHB patients with cirrhosiswere identified from a territorywide
Cohort of patients whowere treated with entecavir (ETV) and/or
Tenofovir disoproxil fumarate (TDF) from January 2005 to December
2016 in Hong Kong. Patients with MELD scores available at baseline
And one year after ETV/TDF were included in the final analysis.
Primaryand secondary outcomewere all-cause mortalityand hepatic
Event based on ICD-9-CM diagnosis codes. Patients with pre-existing
Hepatocellular carcinoma or at first year of antiviral treatment, and
Survival <1 year were excluded.
Results: 1,729 CHB patients (71.0% male, mean age 59.8 ± 11.5 years)
With cirrhosis were identified and followed-up for a median
(interquartile range) of 4.6 (2.6–6.0) years. The mean MELD score
Was 11.2 ± 4.5 at baseline and 9.9 ± 3.4 atoneyear;238 (13.8%) patients
Died. Among 1,191 cirrhotic CHB patients without prior hepatic
Events, 99 (8.3%) patients developed hepatic events. The baseline and
Year 1 MELD score had a time-dependent area under the receiver
Operating characteristic curve (td-AUROC; and 95% confidence
Interval[CI]) of 0.70 (0.67–0.74; P < 0.001) and 0.69 (0.65–0.73; P <
0.001) respectively to all-cause mortality. The td-AUROC of baseline
And Year 1 MELD score was 0.73 (0.67–0.77; P < 0.001) and 0.71
(0.64–0.76; P < 0.001) respectively to predict hepatic event. Adjusted
Hazard ratio (aHR) with 95% CI for baseline MELD and decrease
Of MELD from baseline to Year 1 (DMELD) for all-cause mortality
Was 1.19 (1.16–1.22; P < 0.001) and 0.87 (0.85–0.89; P < 0.001)
Respectively; aHR of baseline and DMELD for hepatic event was 1.20
(1.15–1.25; P < 0.001) and 0.89 (0.85–0.93; P < 0.001) respectively.
Conclusion: MELD score at baseline and one year after antiviral
Treatment predicted all-cause mortality and hepatic events in CHB
Patients with cirrhosis. For each unit of improvement in MELD score
At Year 1, there would be 13% reduction in all-cause mortality and 11%
Reduction in hepatic events in the next 5 years. Our findings support
The current practice of delisting patients for liver transplantation after
Substantial improvement in MELD score after antiviral treatment.

StephenW

EASL 2018 SAT-231
抗病毒药物终末期肝病评分模型减少
治疗预测降低死亡率和肝脏事件的风险
慢性乙型肝炎相关的肝硬化 - 1927患者一项研究
L.-H. Grace Wong1，T.C. Yip2，H. Chan3，Y.-K. Tse4，W.Sun，V.Wong1。
1香港中文大学医学院
Therapeutics，香港，香港; 2香港中文大学
香港吕志和医院大楼7楼94020D室
香港; 3香港中文大学，香港，香港，
香港; 4香港中文大学，香港中文大学7楼94020D室，
香港香港吕志和医学科大楼
电邮：[email protected]
背景和目标：终末期肝病模型
（MELD）是评估慢性肝脏严重程度的评分系统
疾病并优先考虑肝硬化患者肝脏
移植。但关于数据的资料很少
在MELD评分中，抗病毒治疗后导致改善
临床结果和减少肝脏事件。我们的目标是研究
基线和治疗后MELD评分对患者的影响
慢性乙型肝炎（CHB）相关的肝硬化。
方法：从全国范围内确定CHB肝硬化患者
恩替卡韦（ETV）和/或恩替卡韦治疗的患者队列
2005年1月至12月替诺福韦二吡呋酯富马酸盐（TDF）
2016年在香港。基线时可获得MELD评分的患者
ETV / TDF一年后被纳入最终分析。
一级和二级结果均为全因死亡率和肝脏
基于ICD-9-CM诊断代码的事件。预先存在的患者
肝细胞癌或第一年的抗病毒治疗，和
生存期<1年被排除在外。
结果：1,729例CHB患者（男性71.0％，平均年龄59.8±11.5岁）
确定肝硬化并随访中位数
（四分位间距）为4.6（2.6-6.0）年。平均MELD分数
基线时为11.2±4.5，atoneyear为9.9±3.4; 238（13.8％）例患者
死了。在1,191例没有肝脏先前肝硬化的CHB患者中
事件中，99名（8.3％）患者发生肝脏事件。基线和
第一年MELD分数​​在接收器下面有一个时间依赖区
运行特征曲线（td-AUROC; 95％置信度
间隔[CI]）为0.70（0.67-0.74; P <0.001）和0.69（0.65-0.73; P <
0.001）分别为全因死亡率。基线的td-AUROC
第1年MELD评分为0.73（0.67-0.77; P <0.001）和0.71
（0.64-0.76; P <0.001）来预测肝脏事件。调整
基线MELD的风险比（aHR）为95％CI且下降
MELD从基线到1年（DMELD）的全因死亡率
是1.19（1.16-1.22; P <0.001）和0.87（0.85-0.89; P <0.001）
分别;基线和DMELD对肝事件的aHR为1.20
（1.15-1.25; P <0.001）和0.89（0.85-0.93; P <0.001）。
结论：基线和抗病毒药物一年后的MELD评分
治疗预测CHB的全因死亡率和肝脏事件
肝硬化患者。对于MELD分数​​的每个改进单位
在第1年，全因死亡率下降13％，全因死亡率下降11％
未来5年肝脏事件减少。我们的发现支持
目前退役肝移植患者的做法是在肝移植后进行的
抗病毒治疗后MELD评分显着改善。

cctank

回复 StephenW 的帖子

请问下  这些英文原版文章从哪里看的  我在https://ilc-congress.eu/没见到有啊   莫非要去这些企业的官方网站去看？

MP4

cctank 发表于 2018-4-14 09:05
回复 StephenW 的帖子

请问下  这些英文原版文章从哪里看的  我在https://ilc-congress.eu/没见到有啊    ...

http://hbvhbv.info/forum/thread-1699788-1-4.html

StephenW

回复 cctank 的帖子

https://ilc-congress.eu/wp-conte ... -book-201804-13.pdf

摘要是开放的，可以免费下载。 他们通常在实际会议前一周提供

桦子

MELD=3.78×ln[T-BiL(μmol/L)÷17.1]+11.2×ln[INR]+9.57×ln[Cr (μmol/L)÷88.4] + 6.43。

例如：测得1例丙型肝炎终末期肝病患者的总胆红素(T-BiL)为73.6μmol/L，血清肌酐(Cr)为124.0μmol/L，国际标准化比值(INR)为1.54，计算该患者的MELD分数：
MELD=3.78×ln[73.6(μmol/L)÷17.1]+11.2×ln[1.54]+9.57×ln[124.0(μmol/L)÷88.4] + 6.43≈20.04。

桦子

回复 桦子 的帖子

错了，是乙型肝炎，不是丙型肝炎。