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本帖最后由 风雨不动 于 2012-4-14 15:20 编辑
<http://onlinelibrary.wiley.com/doi/10.1111/j.1872-034X.2011.00785.x/abstract>
Long-term outcome and hepatocellular carcinoma development in chronic
hepatitis B or cirrhosis patients after nucleoside analog treatment with
entecavir or lamivudine
Haruhiko Kobashi1,*, Yasuhiro Miyake1, Fusao Ikeda1, Tetsuya Yasunaka1, Ken
Nishino2, Akio Moriya2, Jyunichi Kubota3, Shinichiro Nakamura1, Akinobu
Takaki1, Kazuhiro Nouso1, Gotaro Yamada2, Kazuhide Yamamoto1Article first
published online: 21 MAR 2011
DOI: 10.1111/j.1872-034X.2011.00785.x
© 2011 The Japan Society of Hepatology
Issue
Hepatology Research
Volume 41, Issue 5, pages 405–416, May 2011
Abstract
Aim: We conducted this prospective study to elucidate the long-term
outcome and incidence of hepatocellular carcinoma (HCC) development after
nucleos(t)ide analog (NA) treatment in patients with chronic hepatitis B
(CHB) or cirrhosis.
Methods: CHB or cirrhosis patients without past NA treatment or HCC were
started on entecavir (ETV) or lamivudine (LVD), and prospectively followed
up with monthly blood tests, and with abdominal imaging every 6 months in
CHB and every 3 months in cirrhosis patients.
Results: A total of 256 subjects with CHB (n = 194) or cirrhosis (n =
62) received ETV (n = 129) or LVD (n = 127) for 4.25 years (range:
0.41–10.0). After NA treatment, serum HBV DNA, alanine aminotransferase
and α-fetoprotein (AFP) dropped significantly, along with significant
increases in serum albumin and prothrombin time. Drug-resistance developed
in 60 cases in the LVD group and in only one case in the ETV group. HCC
developed in 35 patients, and the incidence at years 1, 3, 5, 7 and 10 was
significantly higher in patients with cirrhosis (8.1%, 17.5%, 43.2%, 46.7%
and 53.4%, respectively) than chronic hepatitis (1.6%, 3.5%, 3.5%, 7.1% and
29.6%, respectively), with no difference between ETV and LVD. After NA
treatment, the sensitivity/specificity for HCC of AFP and des-γ-carboxy
prothrombin (DCP) was 45.7%/97.3% and 33.3%/96.2%, respectively, with the
specificity of AFP being higher than at baseline (64.4%), at the cut-off of
10 ng/mL.
Conclusion: NA exerted a long-term efficacy and improved hepatic
reservation in CHB and cirrhosis. After NA treatment, AFP dropped to lower
than 10 ng/mL with marked elevation of specificity, leading to an earlier
detection of HCC.
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