肝硬化，非抗病毒治疗，预测具有异质性乙型肝炎病毒状态

StephenW

Gut Liver. 2018 Dec 21. doi: 10.5009/gnl18204. [Epub ahead of print]
Liver Cirrhosis, Not Antiviral Therapy, Predicts Clinical Outcome in Cohorts with Heterogeneous Hepatitis B Viral Status.
Kim MN1, Hwang SG1, Kim BK2, Park JY2, Kim DY2, Han KH2, Kim SU2, Ahn SH2.
Author information

1
    Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
2
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Abstract
Background/Aims:

Antiviral therapy (AVT) reduces the risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis B (CHB). This multicenter retrospective study investigated the effects of AVT and hepatitis B virus (HBV)-related factors on the risk of HCC development in a cohort with heterogeneous HBV status.
Methods:

A total of 1,843 patients with CHB from two institutions were included in this study. Ultrasound and laboratory tests, including the α-fetoprotein test, were conducted regularly to detect HCC development.
Results:

The mean age of our study population (1,063 men and 780 women) was 49.4 years. Cirrhosis was identified in 617 patients (33.5%). During follow-up (median, 42.5 months), 81 patients developed HCC (1.39% per person-year). A total of 645 patients (35.0%) received ongoing AVT at enrollment. Ongoing AVT was not significantly associated with the risk of HCC development (all p＞0.05). HBV-related variables (HBV DNA level, hepatitis B e antigen status, and alanine aminotransferase level) were also not significantly associated with the risk of HCC development (all p>0.05). In contrast, cirrhosis was significantly associated with the risk of HCC development, regardless of adjustment (adjusted hazard ratio=4.098 to 7.020; all p＜0.05). Cirrhosis significantly predicted the risk of HCC development in subgroups with and without ongoing AVT at enrollment, regardless of adjustment.
Conclusions:

Our study showed that cirrhosis, not AVT and HBV-related variables, was associated with HCC development in a cohort of patients with heterogeneous HBV status. Our results may help clinicians to apply individualized surveillance strategies according to fibrotic status in patients with CHB.
KEYWORDS:

Antiviral therapy; Clinical outcome; Fibrosis; Hepatitis B; Liver cirrhosis

PMID:
    30602075
DOI:
    10.5009/gnl18204

StephenW

肠肝。 2018年12月21日doi：10.5009 / gnl18204。 [提前打印]
肝硬化，非抗病毒治疗，预测具有异质性乙型肝炎病毒状态的队列的临床结果。
Kim MN1，Hwang SG1，Kim BK2，Park JY2，Kim DY2，Han KH2，Kim SU2，Ahn SH2。
作者信息

1
    韩国城南大学医学院CHA盆唐医学中心内科
2
    韩国延世大学医学院内科，韩国首尔。

抽象
背景/目的：

抗病毒治疗（AVT）可降低慢性乙型肝炎（CHB）患者发生肝细胞癌（HCC）的风险。这项多中心回顾性研究调查了AVT和乙型肝炎病毒（HBV）相关因素对具有异质HBV状态的队列中HCC发展风险的影响。
方法：

本研究共纳入1,843名来自两个机构的CHB患者。定期进行超声和实验室检查，包括α-胎蛋白检测，以检测HCC的发展。
结果：

我们研究人群的平均年龄（1,063名男性和780名女性）为49.4岁。 617例患者（33.5％）发现肝硬化。在随访期间（中位数为42.5个月），81例患者发生HCC（每人每年1.39％）。共有645名患者（35.0％）在入组时接受了持续的AVT。正在进行的AVT与HCC发展风险无显着相关性（均p> 0.05）。 HBV相关变量（HBV DNA水平，乙型肝炎e抗原状态和丙氨酸氨基转移酶水平）也与HCC发展风险无显着相关性（均p> 0.05）。相反，无论调整如何，肝硬化都与HCC发展的风险显着相关（校正风险比= 4.098至7.020;所有p <0.05）。无论调整如何，肝硬化都显着预测了入组时有和没有持续AVT的亚组患HCC的风险。
结论：

我们的研究表明，肝硬化，而非AVT和HBV相关变量，与一组HBV异质性患者的HCC发展相关。我们的结果可能有助于临床医生根据CHB患者的纤维化状态应用个性化监测策略。
关键词：

抗病毒治疗;临床结果;纤维化;乙型肝炎;肝硬化

结论：
    30602075
DOI：
    10.5009 / gnl18204