慢性乙型肝炎病毒感染的代偿期肝硬化患者的病毒载量低肝

StephenW

Hepatocellular carcinoma risk in chronic hepatitis B virus-infected compensated cirrhosis patients with low viral load

    Dong Hyun Sinn1, Junggyu Lee1, Juna Goo2, Kyunga Kim2, Geum-Youn Gwak1, Yong-Han Paik1, Moon Seok Choi1, Joon Hyeok Lee1, Kwang Cheol Koh1, Byung Chul Yoo1 andSeung Woon Paik1,*

DOI: 10.1002/hep.27889

© 2015 by the American Association for the Study of Liver Diseases

Issue
Cover image for Vol. 61 Issue 5
Hepatology

Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)
Article has an altmetric score of 5

    1    Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
    2    Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea

*Corresponding author: Seung Woon Paik, MD, PhD, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, 135-710, Seoul, South Korea, Tel: +82-2-3410-3409; Fax: +82-2-3410-6983; E-mail: [email protected]

Keywords:

    Liver cancer;antiviral therapy;alanine aminotransferase;treatment;virus

Abstract

Controversy exists about whether antiviral therapy (AVT) should be recommended for compensated cirrhosis patients with chronic hepatitis B virus (HBV) infection and detectable but low serum HBV DNA levels. A retrospective cohort of 385 treatment-naïve, HBV-related compensated cirrhosis patients (mean age 51.1 ± 9.7 years; 66% male) with low HBV DNA levels (<2,000 IU/mL) was assessed for the development of hepatocellular carcinoma (HCC). During median of 5.6 years of follow-up, HCC had developed in 37 (9.6%) patients. The 5-year cumulative HCC incidence rate was 2.2%, 8.0% and 14.0% for patients with undetectable HBV DNA (<12 IU/mL), low HBV DNA levels plus normal alanine aminotransferase (ALT) levels, and low HBV DNA levels plus elevated ALT levels at baseline (p = 0.011). During follow-up, 71 patients maintained undetectable HBV DNA levels, and 126 patients experienced HBV DNA elevation over 2,000 IU/mL. AVT was initiated in 77 patients. In patients without AVT, the 5-year cumulative HCC incidence rates were 13.3%, 8.8% and 1.4% for patients who experienced HBV DNA elevation, patients who maintained detectable but low HBV DNA levels, and patients who maintained undetectable HBV DNA levels, respectively. The 5-year cumulative HCC incidence rate was 5.9% for patients who started AVT; longer AVT duration and longer complete virological response (< 12 IU/mL) duration was associated with lower HCC risk. Conclusion: Compensated cirrhosis patients with detectable but low viral load were not at low risk for HCC, and AVT was associated with lower HCC risk, suggesting that prompt AVT should be considered for these patients. This article is protected by copyright. All rights reserved.

StephenW

慢性乙型肝炎病毒感染的代偿期肝硬化患者的病毒载量低肝癌风险

    东铉Sinn1，Junggyu Lee1，君来Goo2，Kyunga Kim2，今-妍Gwak1，永瀚Paik1，月亮锡Choi1，俊赫Lee1，KWANG哲Koh1，秉哲Yoo1 andSeung焕然Paik1，*

DOI：10.1002 / hep.27889

©2015年肝病研究的美国协会

问题
封面图片卷。 61第5期
肝病

接受第（接受，未编辑的文章，并在网上公布可引用的最终编辑和记录的排版本将出现在未来。）
文章有altmetric比分5

    医药，三星医疗中心，韩国成均馆大学医学院，韩国首尔的1系
    2生物统计学与临床流行病学中心，三星医疗中心，韩国首尔

*通讯作者：承焕白南准，医学博士，医学系，三星医疗中心，韩国成均馆大学医学院，81 Irwon-RO，江南区，135-710，首尔，韩国，电话：+ 82-2 -3410-3409;传真：+ 82-2-3410-6983;电子信箱：[email protected]

关键词：

    肝癌;抗病毒治疗;谷丙转氨酶;治疗;病毒

抽象

存在争议有关的抗病毒治疗（AVT）是否应建议代偿期肝硬化患者的慢性乙型肝炎病毒（HBV）感染与检测，但低血清HBV DNA水平。 385治疗初治，HBV相关代偿期肝硬化患者的回顾性队列（平均年龄51.1±9.7岁; 66％男性），低HBV DNA水平（<2000 IU / ml）的评估肝癌的发展（HCC） 。在5.6年的随访中位数，肝癌37（9.6％）的患者已经发展。在5年累积的HCC发病率为2.2％，8.0％和患者检测不到HBV DNA（<12国际单位/毫升），低HBV DNA水平加上正常丙氨酸转氨酶（ALT）的水平，和低HBV DNA水平加14.0％在基线ALT水平升高（P = 0.011）。在随访期间，71例检测不到​​维持HBV DNA水平，126例患者发生HBV DNA海拔超过2000国际单位/毫升。 AVT始于77例。在患者无AVT，5年累计HCC发生率分别为13.3％，8.8％和谁经历HBV DNA升高，谁维护检测，低HBV DNA水平的患者，和谁保持探测不到的HBV DNA水平的患者患者1.4％，分别为。 5年累积HCC发生率是患者谁开始AVT 5.9％;较长时间AVT和更长的完整的病毒学应答（<12 IU / mL）的持续时间与较低的肝癌风险。结论：代偿期肝硬化患者的检测，但病毒载量低并不低风险肝癌和AVT与较低的肝癌风险相关，这表明AVT提示，应考虑为这些患者。这篇文章是受版权保护的。版权所有。

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结论:可测的低病毒载量代偿性肝硬化病人，发生肝癌的风险不低，抗病毒治疗可以降低肝癌的发生率，建议考虑为这类病人抗病毒治疗。

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韩国研究人员成果