HBV治疗期间MELD评分的变化可降低死亡风险

StephenW

In the Journals
MELD score change during HBV therapy reduces mortality risk

Yip TCF, et al. Am J Gastroenterol. 2018;doi:10.1038/s41395-018-0247-9.
December 6, 2018

On-treatment improvement of MELD scores correlated with reduced risk for all-cause mortality and hepatic events among patients with chronic hepatitis B and cirrhosis, according to a recently published study.

According to Terry Cheuk-Fung Yip, MPhil, from the Chinese University of Hong Kong, and colleagues, an increase in MELD score correlated with new cirrhotic complications and mortality, whereas nucleos(t)ide analogues therapy for chronic HBV led to an improved MELD score.

“MELD score is currently the prevailing criteria for prioritizing patients with end-stage liver disease for liver transplantation,” Yip and colleagues wrote. “On-treatment change of MELD score captures the dynamic change of liver function during antiviral treatment. It reflects the on-treatment modification of natural history of [chronic HBV (CHB)] and the improvement on virological, biochemical, and histological parameters of patients with CHB-related cirrhosis.”

To evaluate the impact of on-treatment change of MELD score on mortality, hepatocellular carcinoma, and hepatic events in patients with CHB-related cirrhosis, Yip and colleagues enrolled 1,743 patients who underwent treatment with entecavir or tenofovir disoproxil fumarate for at least 6 months.

At follow-up, 290 patients died, 201 developed HCC, and 150 patients without a history of hepatic events experienced at least one event.

Mean MELD score decreased from 12.3 at baseline to 11 after 6 months of therapy (P < .001). Serum total bilirubin demonstrated the largest improvement among MELD score components with a mean decrease from 2.4 mg/dL to 1.5 mg/dL (P < .001).

Compared with patients whose score remained at 15 or higher, patients with a MELD score less than 15 at 6 months had a lower risk for mortality (63.8% vs. 21.3%; P < .001) and hepatic events (47.6% vs. 23.2%; P < .001).

Among patients with a baseline MELD score of 15 or higher, decreased MELD score at 6 months correlated with a lower risk for all-cause mortality (HR = 0.86; 95% CI, 0.83-0.89) but did not affect the risk for HCC.

Patients with a MELD score less than 15 at 6 months were younger, more likely to have positive HBV e-antigen, lower serum creatinine, and higher platelet counts, serum albumin, total bilirubin, serum HBV DNA, and alanine aminotransferase levels at baseline than patients with a MELD score of 15 or higher at 6 months.

“Our findings showed that patients with MELD score [less than] 15 after 6-month of treatment are associated with reduced risk of all-cause mortality and hepatic events in the next 5.5 years,” Yip and colleagues wrote. “This agrees with the recommendation of using 15 as cut-off of MELD score for the allocation of liver transplantation.” – by Talitha Bennett

Disclosure: Yip reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

StephenW

在期刊上
HBV治疗期间MELD评分的变化可降低死亡风险

Yip TCF，et al。 Am J Gastroenterol。 2018; DOI：10.1038 / s41395-018-0247-9。
2018年12月6日

根据最近发表的一项研究，MELD评分的治疗改善与慢性乙型肝炎和肝硬化患者的全因死亡率和肝脏事件风险降低相关。

来自香港中文大学的MPhil及其同事Terry Cheuk-Fung Yip表示，MELD评分的增加与新的肝硬化并发症和死亡率相关，而核苷（酸）类似物治疗慢性HBV导致MELD改善得分了。

“目前，MELD评分是优先考虑肝移植终末期肝病患者的主流标准，”Yip及其同事写道。 “MELD评分的治疗变化记录了抗病毒治疗期间肝功能的动态变化。它反映了[慢性HBV（CHB）]自然史的治疗改变以及CHB相关性肝硬化患者的病毒学，生物化学和组织学参数的改善。“

为了评估MELD评分的治疗变化对CHB相关性肝硬化患者的死亡率，肝细胞癌和肝脏事件的影响，Yip及其同事招募了1,743名接受恩替卡韦或替诺福韦地索普西富马酸盐治疗至少6个月的患者。

随访时，290例患者死亡，201例发生HCC，150例无肝脏事件史的患者至少经历过一次事件。

治疗6个月后，平均MELD评分从基线时的12.3降至11（P <.001）。血清总胆红素在MELD评分中表现出最大的改善，平均从2.4 mg / dL降至1.5 mg / dL（P <.001）。

与评分保持在15或以上的患者相比，6个月MELD评分低于15的患者死亡风险较低（63.8％对21.3％; P <.001）和肝脏事件（47.6％对23.2％） ％; P <.001）。

在基线MELD评分为15或更高的患者中，6个月时MELD评分降低与全因死亡风险降低相关（HR = 0.86; 95％CI，0.83-0.89），但不影响HCC风险。

MELD评分在6个月时低于15的患者更年轻，更可能具有阳性HBV e抗原，血清肌酐更低，血小板计数，血清白蛋白，总胆红素，血清HBV DNA和基线丙氨酸氨基转移酶水平高于MELD评分在6个月时为15或更高的患者。

“我们的研究结果显示，治疗6个月后MELD评分[小于] 15的患者与未来5。5年内全因死亡率和肝脏事件的风险降低相关，”Yip及其同事写道。 “这与使用15作为肝移植分配的MELD评分截止值的建议一致。” - 作者：Talitha Bennett

披露：叶先生没有相关的财务披露报告。有关其他作者的相关财务披露，请参阅完整的研究。