核苷类似物治疗慢性乙型肝炎患者对肝癌的倾向分析

StephenW

Effect of nucleos(t)ide analogue therapy on hepatocarcinogenesis in chronic hepatitis B patients: A propensity score analysis

    Takashi Kumada ,    Hidenori Toyoda    ,    Toshifumi Tada    ,    Seiki Kiriyama
   
    Makoto Tanikawa    ,    Yasuhiro Hisanaga    ,    Akira Kanamori    ,
    Takurou Niinomi    ,    Satoshi Yasuda    ,    Yusuke Andou    ,
    Kenta Yamamoto    ,    Junko Tanaka

Background & Aims

Some patients with chronic hepatitis B virus (HBV) infection progress to hepatocellular carcinoma (HCC). However, the long-term effect of nucleos(t)ide analogue (NA) therapy on progression to HCC is unclear.
Methods

Therefore, we compared chronic hepatitis B patients who received NA therapy to those who did not, using a propensity analysis.
Results

Of 785 consecutive HBV carriers between 1998 and 2008, 117 patients who received NA therapy and 117 patients who did not, were selected by eligibility criteria and propensity score matching. Factors associated with the development of HCC were analyzed. In the follow-up period, HCC developed in 57 of 234 patients (24.4%). Factors significantly associated with the incidence of HCC, as determined by Cox proportional hazards models, include higher age (hazard ratio, 4.36 [95% confidence interval, 1.33–14.29], p=0.015), NA treatment (0.28 [0.13–0.62], p=0.002), basal core promoter (BCP) mutations (12.74 [1.74–93.11], p=0.012), high HBV core-related antigen (HBcrAg) (2.77 [1.07–7.17], p=0.036), and high gamma glutamyl transpeptidase levels (2.76 [1.49–5.12], p=0.001).
Conclusions

NA therapy reduced the risk of HCC compared with untreated controls. Higher serum levels of HBcrAg and BCP mutations are associated with progression to HCC, independent of NA therapy.

StephenW

背景与目的

有些患者在慢性乙型肝炎病毒（HBV）感染的进展肝细胞癌（HCC）。然而，进展为HCC的核苷（酸）类似物（NA）治疗的长期效果目前还不清楚。
方法

因此，我们比较慢性乙型肝炎患者接受NA治疗那些谁没有，使用的倾向分析。
结果

785连续乙肝病毒携带者在1998年和2008年之间，117例患者接受NA治疗的117例患者没有选择的资格标准和倾向得分匹配。与HCC的发展有关的因素进行了分析。在随访期间，57234例（24.4％）HCC发展。与肝癌的发病率，采用Cox比例风险模型，确定有显著相关联的因素，包括年龄（危险比为4.36[95％可信区间为1.33-14.29，P = 0.015），NA治疗（0.28[0.13-0.62] ，P= 0.002），基本核心启动子（BCP）突变（12.74[1.74-93.11]，P = 0.012），高HBV核心抗原（HBcrAg）（2.77[1.07-7.17]，p = 0.036），和高伽玛谷氨酰转水平（2.76[1.49-5.12]，p = 0.001）。
结论

与未经处理的对照组相比，NA治疗肝癌的危险降低。较高的血清水平的HBcrAg和BCP突变与进展为HCC，独立的NA治疗。