High Levels of Hepatitis B Surface Antigen Increase Risk of Hepatocellular Carci

StephenW

http://www.gastrojournal.org/article/S0016-5085%2812%2900172-2/abstract
High Levels of Hepatitis B Surface Antigen Increase Risk of Hepatocellular Carcinoma in Patients with Low HBV Load

• Tai-Chung Tseng
  ,
• Chun-Jen Liu
  ,
• Hung-Chih Yang
  ,
• Tung-Hung Su
  ,
• Chia-Chi Wang
  ,
• Chi-Ling Chen
  ,
• Stephanie Fang-Tzu Kuo
  ,
• Chen-Hua Liu
  ,
• Pei-Jer Chen
  ,
• Ding-Shinn Chen
  ,
• Jia-Horng Kao
  

Received 10 September 2011; received in revised form 5 February 2012; accepted 7 February 2012.  published online 13 February 2012.
Accepted Manuscript

Abstract
Background & Aims
Patients with chronic hepatitis B virus (HBV) infection have a high risk for developing hepatocellular carcinoma (HCC). Patients with lower levels of hepatitis B surface antigen (HBsAg) have higher chances of losing HBsAg than those with high levels. However, little is known about whether higher levels of HBsAg increase the risk for HCC.
Methods
We followed 2688 Taiwanese HBsAg-positive patients without evidence of cirrhosis for a mean time period of 14.7 years. In addition to known risk factors of HCC, we investigated association between levels of HBsAg and the development of HCC.
Results
Of the patients followed, 191 developed HCC, with an average annual incidence rate of 0.5%. Baseline levels of HBsAg and HBV were associated with the development of HCC, and risk increased with level. Compared to HBsAg level, by receiver operating characteristic curve analysis, HBV DNA level better predicted the development of HCC over 10-year and 15-year periods (both P<.001). However, when we evaluated hepatitis B e antigen (HBeAg)-negative patients with levels of HBV DNA <2000 IU/mL, factors that determined HCC risk included sex, age, and levels of alanine aminotransferase (ALT) and HBsAg (≧1000 IU/mL), but not level of HBV DNA. Multivariate analysis showed that the adjusted hazard ratio for HCC in patients with levels of HBsAg ≧1000 vs <1000 IU/mL was 13.7 (95% confidence interval, 4.8–39.3).
Conclusions
Among patients infected with HBV genotypes B or C, determinants of HCC risk include their sex, age, HBeAg status, HBV genotype and levels of ALT and HBV DNA, but not level of HBsAg. Among HBeAg-negative patients with low viral loads, HCC risk is determined by levels of HBsAg and ALT and age, but not HBV DNA.

StephenW

乙肝表面抗原增加肝癌风险高的水平，在低HBV负荷的患者

    曾大涌
    ，
    刘淳仁
    ，
    杨泓志
    ，
    苏东红
    ，
    王林嘉绮
    ，
    陈智灵
    ，
    斯蒂芬妮方慈济国
    ，
    刘珍华
    ，
    陈北哲
    ，
    陈定信
    ，
    高嘉鸿

2011年9月10日收到2012年2月在修订后的表格5; 2012年2月7日。 2012年2月13日网上公布。
接受手稿
摘要背景与慢性乙型肝炎病毒（HBV）感染AimsPatients有发展肝细胞癌（HCC）的高风险。失去比那些水平高的乙肝表面抗原与乙肝表面抗原（HBsAg）水平较低的患者有更高的机会。然而，知之甚少较高水平的HBsAg是否增加肝癌的风险。
其次MethodsWe 2688台湾乙肝表面抗原阳性的患者，没有证据表明肝硬化的平均时间为14.7年。除了已知的危险因素，肝癌，我们调查之间协会HBsAg水平与肝癌的发展。
ResultsOf患者随访，191开发的肝癌，平均年发病率为0.5％。 HBsAg和HBV的基线水平与肝癌的发展，与同级别的风险增加。 HBsAg水平相比，受试者工作特征曲线分析，HBV DNA水平更好地预测肝癌的发展超过10年和15年期（均P <.001）。然而，当我们评估B型肝炎e抗原（HBeAg）阴性患者HBV DNA水平<2000 IU / mL时，确定肝癌的风险因素包括性别，年龄，和丙氨酸转氨酶（ALT）和乙肝表面抗原的水平（≧1000国际单位/毫升），但不HBV DNA水平。多元统计分析表明，肝癌患者的乙肝表面抗原≧1000与水平调整后的危险比<1000 IU / mL的为13.7（95％置信区间，4.8-39.3）。
ConclusionsAmong患者感染HBV基因型B或C，肝癌的危险因素包括他们的性别，年龄，HBeAg状态，HBV基因型及ALT和HBV DNA水平，而不是乙肝表面抗原水平。在HBeAg阴性患者病毒载量低，肝癌的风险是由HBsAg和ALT水平和年龄确定，但不乙型肝炎病毒DNA。