抗病毒治疗可以延长免疫耐受乙肝患者的生存期

StephenW

Antiviral therapy prolongs survival in immune tolerant hepatitis B patients
Nucleos(t)ide analogue treatment reduces risk of developing liver cancer and liver cirrhosis among immune tolerant patients

Date:
    April 15, 2016
Source:
    European Association for the Study of the Liver
Summary:
    A new study demonstrates that the use of antiviral therapy for patients in the immune tolerant phase of hepatitis B (HBV) prolongs overall survival and reduces the risk of the most common form of liver cancer (Hepatocellular Carcinoma, HCC) and scarring of the liver (cirrhosis).

FULL STORY

A new study, presented today at The International Liver Congress™ 2016 in Barcelona Spain, demonstrates that the use of antiviral therapy for patients in the immune tolerant phase of Hepatitis B (HBV) prolongs overall survival and reduces the risk of the most common form of liver cancer (Hepatocellular Carcinoma, HCC) and scarring of the liver (cirrhosis).

The study showed that the risks of developing HCC and liver cirrhosis were significantly lowered among those who received nucleos(t)ide analogue treatment.

Hepatitis B is the most common serious liver infection in the world. It is caused as the virus, transmitted through blood and infected bodily fluids, attacks the liver.1 In the immune tolerant stage, HBV actively replicates in the liver, but remains unrecognised by the immune system. Patients can remain in this stage for decades with high viral load but no apparent damage to the liver.2 There are two treatment options for HBV immune tolerant patients: pegylated interferon strategy, or nucleos(t)ide analogues.3

"Our study demonstrates that nucleos(t)ide analogue treatment offers promising results in reducing the risk of liver cancer and damage among those patients who have limited treatment options," said Professor Jeong-Hoon Lee of the Liver Research Institute at Seoul National University, Korea and corresponding author of the study. "Furthermore, in contrast to the control group who received no treatment during immune tolerant phase, overall survival was significantly prolonged for those who received nucleos(t)ide analogue treatment."

The single-center retrospective study was conducted in 644 patients diagnosed as HBeAg-positive chronic HBV (an indicator of active viral replication) with alanine aminotransferase levels within two times of upper normal limit, without evidence of liver cirrhosis. Patients were divided into two groups, the group who received antiviral therapy and the control group who received no therapy until the immune-active phase. The primary endpoint of the study was overall survival and secondary endpoints were the development of HCC and liver cirrhosis.

After balancing for baseline characteristics between the two groups, the risk of developing HCC (Hazard Ratio [HR]= 0.084; 95% Confidence Interval [CI]=0.030-0,234; p<0.001) and liver cirrhosis (HR=0.250, 95% CI=0.089-0.707; p=0.009) were significantly lower in the antiviral group. Furthermore, antiviral treatment significantly prolonged overall survival compared to the control group (HR=0.059, 95% CI=0.008-0.415; p=0.005).

"This study results are significant in helping to advance medical alternatives for patients with immune tolerant Hepatitis B, a sub-group of patients who thus far, doctors have been hesitant to treat," said Professor Tom Hemming Karlsen, EASL Vice-Secretary.

References

1 Hepatitis B Foundation. About Hepatitis B. Published: January 2014. Available from: http://www.hepb.org/hepb/about_hepatitis_b.htm. Last accessed: March 2016.

2 Hepatitis B Foundation. Hepatitis B Blog: Diagnosed with Chronic Hepatitis B? What State- Immune Tolerant? Published: December 2012. Available from: http://hepbblog.org/2012/12/07/g ... are-you-in-part-i/. Last accessed: March 2016.

3 Tseng, C. et al. Treating Immune-tolerant Hepatitis B. Journal of Viral Hepatitis. 2014;22 (2): 1-8.

Story Source:

The above post is reprinted from materials provided by European Association for the Study of the Liver. Note: Materials may be edited for content and length.

StephenW

抗病毒治疗可以延长免疫耐受乙肝患者的生存期
核苷（酸）类似物IDE治疗降低开发免疫耐受患者肝癌和肝硬化的危险性

日期：
    2016年4月15日
资源：
    欧洲协会肝脏的研究
概要：
    一项新的研究表明，在B型肝炎病毒（HBV）的免疫耐受期使用的抗病毒治疗的患者延长整体存活率并降低肝癌的肝（肝细胞癌，肝癌）和瘢痕形成的最常见的形式的风险（肝硬化）。

全文

一项新的研究，今天在国际肝病会议™2016年在西班牙巴塞罗那提出，表明乙肝（HBV）的免疫耐受期使用抗病毒治疗的患者延长总生存期，并减少的最常见形式的风险肝癌（肝细胞癌，HCC）和肝脏（肝硬化）的疤痕。

研究表明，显影肝癌和肝硬化的风险的那些谁收到核苷（酸）IDE类似物治疗中均显著降低。

乙型肝炎是最常见的严重肝感染在世界上。它是引起作为病毒，通过血液和受感染的体液传播，攻击liver.1在免疫耐受阶段，HBV积极复制在肝，但仍然被免疫系统无法识别。病人可以留在这个阶段，几十年来高病毒载量，但到liver.2没有明显的损伤有乙肝病毒免疫耐受患者两种治疗方案：聚乙二醇干扰素策略，或核苷（酸）IDE analogues.3

“我们的研究表明，核苷（酸）IDE类似物治疗降低肝癌和损害的那些谁拥有有限的治疗选择的患者中的风险提供了可喜的成果，”肝研究院在首尔国立大学的郑勋李教授说，韩国和研究的通讯作者。 “此外，相对于在谁免疫耐受期未接受治疗的对照组，总生存期延长显著为那些谁接受核苷（酸）类似物IDE治疗。”

单中心回顾性研究中诊断为HBeAg阳性慢性HBV（活性病毒复制的指标）与内的正常上限的两倍谷丙转氨酶水平644患者中进行，没有肝硬化的证据。患者分为两组，谁收到抗病毒治疗和谁收到无治疗，直至免疫活性相，对照组的组。该研究的主要终点是总生存和次要终点是肝癌和肝硬化的发展。

这两个群体之间的基线特征平衡后，发展为HCC的风险（风险比[HR] = 0.084; 95％置信区间[CI] = 0.030-0,234; P <0.001），肝硬化（HR = 0.250，95％ CI = 0.089-0.707; p = 0.009）分别在抗病组显著降低。此外，抗病毒治疗显著延长整体存活率相比对照组（HR = 0.059; 95％CI = 0.008-0.415; P = 0.005）。

“这项研究结果是在帮助促进患者的免疫耐受乙肝，子组的谁迄今为止，医生们一直在犹豫治疗患者的医疗方案显著，”汤姆海明卡尔森教授，EASL副局长说。

参考

1乙型肝炎基金会。关于乙型肝炎发布时间：http://www.hepb.org/hepb/about_hepatitis_​​b.htm：2014年一月从可用。最后访问时间：2016年3月。

2乙型肝炎基金会。乙肝博客：慢性乙型肝炎诊断？什么述明─免疫耐受？发布时间：2012年12月可供自：http://hepbblog.org/2012/12/07/g ... -are-you-in-part-i/。最后访问时间：2016年3月。

3曾国藩，C等。治疗免疫耐受乙型肝炎杂志病毒性肝炎。 2014年; 22（2）：1-8。

故事来源：

上述职位由欧洲协会肝病研究学会提供的材料转载。注：材料可用于内容和长度进行编辑。