Changes in Serum Levels of HBV DNA and Alanine Aminotransferase Determine Risk f

StephenW

http://www.gastrojournal.org/article/S0016-5085%2811%2900815-8/abstract
Changes in Serum Levels of HBV DNA and Alanine Aminotransferase Determine Risk for Hepatocellular Carcinoma

• Chuen–Fei Chen
• Wen–Chung Lee
• Hwai–I. Yang
• Hung–Chuen Chang
• Chin–Lan Jen
• Uchenna H. Iloeje
• Jun Su
• Chuhsing K. Hsiao
• Li–Yu Wang
• San–Lin You
• Sheng–Nan Lu
• Chien–Jen Chen
• Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer in HBV (REVEAL–HBV) Study Group
  

Received 8 December 2010; accepted 3 June 2011.  published online 23 June 2011.

Background & AimsIt is not clear whether risk for hepatocellular carcinoma can be accurately determined from long-term changes in serum levels of hepatitis B virus (HBV) DNA or alanine aminotransferase (ALT).
Methods:
We measured serum levels of HBV DNA and ALT at enrollment and during follow-up analysis of 3160 participants in the REVEAL-HBV study. Development of hepatocellular carcinoma was determined from follow-up examinations and computerized linkage with National Cancer Registry and National Death Certification profiles. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models.
Results:
During 38,330 person-years of follow-up, 81 participants developed hepatocellular carcinoma (incidence rate, 211.3/100,000 person-years). The risk for hepatocellular carcinoma was only slightly higher for participants whose follow-up levels of HBV DNA spontaneously decreased to <10,000 copies/mL compared with those with baseline levels of HBV DNA <10,000 copies/mL (control group; HR, 2.25; 95% CI, 0.68–7.37). Compared with the control group, the HRs (95% CI) for long-term levels of HBV DNA that persisted at 10,000 to 100,000 copies/mL, decreased to/persisted at 100,000 to 1,000,000 copies/mL, or decreased to/persisted at 1,000,000 to 10,000,000 copies/mL were 3.12 (1.09–8.89), 8.85 (3.85–20.35), and 16.78 (7.33–38.39), respectively. A gradient in ALT level was significantly associated with hepatocellular carcinoma risk: from all low-normal, to ever high-normal, to transient abnormal, to persistent abnormal (Ptrend < .001).
Conclusions:
Long-term changes in serum levels of HBV DNA and ALT are independent predictors of risk for hepatocellular carcinoma. Regular monitoring of levels of HBV DNA and ALT is important in clinical management of chronic carriers of HBV.




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StephenW

[谷歌翻译是不是100％正确，仅供参考使用。]

背景及目的

目前尚不清楚是否为肝癌的风险，可以准确地从血清乙型肝炎病毒（HBV）DNA或丙氨酸转氨酶（ALT）水平的长期变化确定。
方法

我们在入学和在3160 REVEAL- HBV的研究参与者的后续分析测量血清HBV DNA和ALT水平。从后续检查和与国家癌症登记处和国家的死亡证书型材的电脑化联动，肝癌发展的决心。使用Cox回归模型估计的多因素调整后的危险比（HR）和95％可信区间（CI）。
结果

在38330的人 - 年随访，81参与者开发肝细胞癌（发病率，211.3/100，000人年）。肝癌的风险仅略高于参与者的后续自发地降低HBV DNA水平与HBV DNA<10,000拷贝/ ml（对照组基线水平相比，<10,000 copies / mL的; HR，2.25;95 ％CI，0.68-7.37）。与对照组，长期的HBV DNA水平，坚持在10,000到100,000拷贝/ ml小时（95％CI），相比下降/坚持在10万至100万拷贝/毫升，或下降到/坚持1,000,000 1000万拷贝/ ml分别为3.12（1.09-8.89），8.85（3.85-20.35），16.78（7.33-38.39），分别为。与肝癌的风险显着相关的ALT水平的梯度：从所有低正常，到以往正常高，瞬态异常，持续性异常（Ptrend<.001）。
结论

在血清HBV DNA和ALT水平的长期变化是肝癌风险的独立预测因素。定期监测HBV DNA和ALT水平是很重要的HBV慢性携带者的临床管理。