基于人群的恩替卡韦研究和慢性乙型肝炎相关失代偿期肝硬

StephenW

Clin Res Hepatol Gastroenterol. 2019 Mar 25. pii: S2210-7401(19)30049-X. doi: 10.1016/j.clinre.2019.02.010. [Epub ahead of print]
Population-based study of Entecavir and long-term mortality in chronic hepatitis B-related decompensated liver cirrhosis.
Hung TH1, Tsai CC2, Lee HF3.
Author information

1
    Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
2
    Department of Mathematics, Tamkang University, Tamsui, Taiwan.
3
    Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan. Electronic address: [email protected].

Abstract
BACKGROUND AND AIMS:

We lack population-based studies that identify the role of entecavir (ETV) in extending long-term survival in chronic hepatitis B (CHB)-related decompensated liver cirrhotic patients. Since 2010, National Health Insurance in Taiwan has covered long-term medical payment for antiviral therapy in CHB-related cirrhotic patients whose HBV DNA is ≥ 2000 IU/mL. We studied the effect of ETV on the mortality of CHB-related decompensated cirrhosis patients compared with patients who did not receive antiviral agents at baseline.
METHODS:

From the Taiwan National Health Insurance Database, we collected 758 CHB-related decompensated cirrhosis patients with elevated viral loads (HBV DNA ≥ 2000  IU/mL) using ETV and discharged between January 1, 2010, and December 31, 2013. The comparison group consisted of 1516 selected CHB-related decompensated cirrhotic patients without antiviral therapy at baseline using propensity score matching analysis.
RESULTS:

The 1-, 2-, and 3-year mortality probabilities were 34.7%, 42.5%, and 48.5 % in the ETV group and 21.1%, 37.8% and 51.3 % in the non-ETV group, respectively. Based on a Cox proportional hazards regression model adjusted by patients' sex, age, and comorbid disorders, the hazard ratios (HR) in the ETV group for 1-year, 1-2-year, and 2-3-year mortalities were 1.22 (95% confidence interval [CI] 1.05-1.43, P = .010), 1.02 (0.86-1.20, P = .866), and 0.59 (0.38-0.90, P = .016), compared with the non-ETV group.
CONCLUSIONS:

Even in CHB-related decompensated cirrhotic patients, higher initial viral loads were correlated with poor outcomes. However, the long-term usage of ETV can decrease long-term mortality in these patients.

Copyright © 2019 Elsevier Masson SAS. All rights reserved.
KEYWORDS:

Chronic hepatitis B; Decompensated liver chirrhosis; Entecavir

PMID:
    30922728
DOI:
    10.1016/j.clinre.2019.02.010

StephenW

Clin Res Hepatol Gastroenterol。 2019年3月25日.pii：S2210-7401（19）30049-X。 doi：10.1016 / j.clinre.2019.02.010。 [印刷前的电子版]
基于人群的恩替卡韦研究和慢性乙型肝炎相关失代偿期肝硬化的长期死亡率。
Hung TH1，Tsai CC2，Lee HF3。
作者信息

1
    台湾嘉义佛教大林慈济医院医学科消化内科;台湾花莲市慈济大学医学院。
2
    淡江大学数学系，台湾淡水。
3
    台湾嘉义佛教大林慈济医院医学科消化内科;台湾花莲市慈济大学医学院。电子地址：[email protected]。

抽象
背景和目的：

我们缺乏基于人群的研究，这些研究确定恩替卡韦（ETV）在延长慢性乙型肝炎（CHB）相关失代偿肝硬化患者的长期生存方面的作用。自2010年以来，台湾国民健康保险已承担了HBV DNA≥2000IU / mL的CHB相关肝硬化患者的抗病毒治疗的长期医疗费用。我们研究了ETV对CHB相关失代偿期肝硬化患者死亡率的影响，与基线时未接受抗病毒药物的患者相比。
方法：

来自台湾国民健康保险数据库，我们收集了758名与CHB相关的失代偿期肝硬化患者，这些患者使用ETV升高了病毒载量（HBVDNA≥2000IU / mL），并于2010年1月1日至2013年12月31日期间出院。对照组包括使用倾向评分匹配分析，在基线时选择了1516名未经抗病毒治疗的CHB相关失代偿性肝硬化患者。
结果：

ETV组的1年，2年和3年死亡率概率分别为34.7％，42.5％和48.5％，非ETV组分别为21.1％，37.8％和51.3％。根据患者性别，年龄和合并症调整的Cox比例风险回归模型，ETV组1年，1  -  2年和2  -  3年死亡率的风险比（HR）为1.22 （95％可信区间[CI] 1.05-1.43，P = .010），1.02（0.86-1.20，P = .866），和0.59（0.38-0.90，P = .016），与非ETV组相比。
结论：

即使在与CHB相关的失代偿期肝硬化患者中，较高的初始病毒载量与较差的结果相关。然而，长期使用ETV可降低这些患者的长期死亡率。

版权所有©2019 Elsevier Masson SAS。版权所有。
关键词：

慢性乙型肝炎;失代偿肝硬化;恩替卡韦

结论：
    30922728
DOI：
    10.1016 / j.clinre.2019.02.010