一项大型的现实世界队列研究研究了长期恩替卡韦

StephenW

J Viral Hepat. 2019 Nov 21. doi: 10.1111/jvh.13237. [Epub ahead of print]
A large real-world cohort study examining the effects of long-term entecavir on hepatocellular carcinoma and HBsAg seroclearance.
Ko KL1, To WP1, Mak LY1, Seto WK1,2, Ning Q3, Fung J1,2, Lai CL1,2, Yuen MF1,2.
Author information

1
    Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
2
    State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong.
3
    Institute of Infectious Disease, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.

Abstract

Real world studies examining reduction in risk of hepatocellular carcinoma (HCC) in patients receiving antivirals are limited by the small size of the studies, or by data insufficiency and heterogeneity with short follow-up duration. We aimed to examine the real-world long-term outcome of patients receiving entecavir treatment on HCC incidence and HBsAg seroclearance. The incidence of HCC in 1225 entecavir-treated patients between 2002 and 2015 was compared with the HCC incidence estimated using the REACH-B, GAG-HCC and CU-HCC scores. Standardized incidence ratios (SIR) were calculated. The impact of entecavir treatment on HBsAg seroclearance was also explored. The median follow-up of the cohort was 6.6 years, with 66 cases of HCC development. Using the REACH-B model, the reduction of HCC risk was significant from year 6 onwards with SIR of 0.68 (95% CI 0.535-0.866) at year 10. In subgroup patients without cirrhosis, consistent risk reduction was observed from the fifth year and the SIR reached 0.51 (95% CI 0.271-0.704) by year 10. Benefit in cirrhotic patients was demonstrated when using the GAG-HCC and CU-HCC score, with the SIR at year 10 being 0.38 (95% CI 0.259-0.544) and 0.46 (95% CI 0.314-0.659) respectively. The cumulative rate of HBsAg seroclearance was 5.2%. HBsAg level at third year of treatment and baseline-to-3-year percentage reduction were predictive of subsequent HBsAg seroclearance. In conclusion, long-term entecavir therapy was associated with significant reduction in the risk of HCC in the real world. However, HBsAg seroclearance rate remained low. Additional therapy may be considered in patients with adverse predictive factors for subsequent HBsAg seroclearance.

© 2019 John Wiley & Sons Ltd.
KEYWORDS:

Chronic hepatitis B; Entecavir; HBsAg seroclearance; Hepatocellular carcinoma

PMID:
    31755196
DOI:
    10.1111/jvh.13237

StephenW

J病毒性肝炎。 2019年11月21日.doi：10.1111 / jvh.13237。 [Epub提前发布]
一项大型的现实世界队列研究研究了长期恩替卡韦对肝细胞癌和HBsAg血清清除的影响。
Ko KL1，To WP1，Mak LY1，Seto WK1,2，Ning Q3，Fung J1,2，Lai CL1,2，Yen MF1,2。
作者信息

1个
    香港大学玛丽医院香港大学医学系。
2
    香港大学肝脏研究国家重点实验室。
3
    华中科技大学同济医院传染病研究所，武汉。

抽象

现实世界中研究接受抗病毒药物治疗的患者降低肝细胞癌（HCC）风险的研究受限于研究规模小或数据不足和异质性差，且随访时间短。我们旨在检查接受恩替卡韦治疗的患者在HCC发生率和HBsAg血清清除率方面的真实长期结果。将2002年至2015年期间接受1225例恩替卡韦治疗的患者的HCC发生率与使用REACH-B，GAG-HCC和CU-HCC得分估算的HCC发生率进行了比较。计算标准化的发病率（SIR）。还探讨了恩替卡韦治疗对HBsAg血清清除的影响。该队列的中位随访时间为6.6年，有66例HCC发生。使用REACH-B模型，从第6年开始，HCC风险显着降低，第10年的SIR为0.68（95％CI 0.535-0.866）。在没有肝硬化的亚组患者中，从第五年开始观察到持续降低的风险，到第10年时，SIR达到0.51（95％CI 0.271-0.704），使用GAG-HCC和CU-HCC评分可证明肝硬化患者的获益，第10年的SIR为0.38（95％CI 0.259-0.544）和0.46（95％CI 0.314-0.659）。 HBsAg血清清除率的累积率为5.2％。治疗第三年的HBsAg水平和基线至3％的百分比降低可预测随后的HBsAg血清清除率。总之，长期使用恩替卡韦治疗可大大降低现实世界中HCC的风险。但是，HBsAg血清清除率仍然很低。对于具有随后HBsAg血清清除不良预测因素的患者，可以考虑采用其他疗法。

©2019 John Wiley＆Sons Ltd.
关键字：

慢性乙型肝炎；恩替卡韦; HBsAg血清清除；肝细胞癌

PMID：
    31755196
DOI：
    10.1111 / jvh.13237

纠结哥哥

早期肝硬化算不算肝硬化？

newchinabok

纠结哥哥 发表于 2019-11-23 21:31
早期肝硬化算不算肝硬化？

是肝硬化，重度肝纤维化也是肝硬化

纠结哥哥

回复 newchinabok 的帖子

不是吧 骆抗先说早期肝硬化是重度肝炎，不算肝硬化啊。以前肝弹10.5吃了两年药，目前肝弹6.6 这个算什么

傻狍子7号

这个意思是：使用reach-B模型计算，到第十年，吃恩替的肝癌发病率是预期率的0.68倍。
对于没有肝硬化的乙 肝患者，第十年吃恩替的肝癌发病率是不治疗的0.51倍（风险下降了49%）。
所以吃恩替肝癌发病率下降还不到一半啊。。。。