[英语，临床]Long-term outcome & HCC after ent or lam treatment

StephenW

<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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StephenW

长期发展的结果和肝癌，慢性
B型肝炎或肝硬化的患者治疗后核苷类似物
恩替卡韦或拉米夫定

晴彦Kobashi1，*，中曾根Miyake1，房雄Ikeda1，哲也Yasunaka1，肯
Nishino2，昭雄Moriya2，Jyunichi Kubota3，真一郎Nakamura1，昭信
Takaki1，弘Nouso1，Gotaro Yamada2，第一次和秀Yamamoto1Article
发表时间：2011年3月21日

分类号：10.1111/j.1872-034X.2011.00785.x
© 2011日本肝病学会
发行

肝脏病学研究
第41卷，第5期，页405-416，2011年5月

摘要

目的：我们进行这项前瞻性研究，以阐明长期
结果和肝细胞癌（HCC）的发生率后的发展
核苷（酸）的IDE模拟（NA）的治疗慢性乙型肝炎患者
（乙肝）或肝硬化。

方法：没有过去不适用治疗慢性乙肝或肝硬化或肝癌患者
开始替卡韦（ETV）或拉米夫定（LVD）的，并前瞻性随访
与每月的血液测试，并与腹部影像每6个月
慢性乙肝和肝硬化患者每3个月。

结果：256例慢性乙型肝炎科目组（n = 194）或肝硬化（N总=
62）获得4.25年（范围ETV组（n = 129）或LVD组（n = 127）：
0.41-10.0）。北美治疗后，血清HBV DNA，丙氨酸氨基转移酶
和α-甲胎蛋白（AFP）显着下降，伴随着显着
增加血清白蛋白，凝血酶原时间。耐药性开发
在LVD组60例中只有一个在ETV集团为例。肝癌
开发的35例，发病率在第1年，3，5，7和10是
显着高于肝硬化患者（8.1％，17.5％，43.2％，46.7％
和53.4％）明显高于慢性肝炎（1.6％，3.5％，3.5％，7.1％和
29.6％，分别），与ETV和LVD之间没有差异。经过不适用
治疗的敏感性/特异性肝癌甲胎蛋白和des -γ-羧基
凝血酶原（DCP）的为45.7％/ 97.3％和33.3％/ 96.2％，分别与
特异性被比基准（64.4％），较高的在法新社，截止
10毫微克/毫升。

结论：不适用产生了长期疗效和改善肝
慢性乙肝和肝硬化的保留。治疗后不适用，法新社下降到较低
超过10纳克/与毫升的特异性显着升高，从而导致早期
检测肝癌。