系统评价与Meta分析：慢性乙型肝炎患者的乙肝表面抗原血清

StephenW

Systematic review with meta-analysis: development of hepatocellular carcinoma in chronic hepatitis B patients with hepatitis B surface antigen seroclearance

    F. Liu1, X.-W. Wang1, L. Chen1,2, P. Hu1, H. Ren1 andH.-D. Hu1,2,*

Article first published online: 27 APR 2016

DOI: 10.1111/apt.13634

© 2016 John Wiley & Sons Ltd

Issue

Alimentary Pharmacology & Therapeutics

Volume 43, Issue 12, pages 1253–1261, June 2016
Article has an altmetric score of 2

    1    Key Laboratory of Molecular Biology for Infectious Diseases, Department of Infectious Diseases, Institute for Viral Hepatitis, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
    2    Department of Clinical Nutrition, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

* Correspondence to:
Dr H.-D. Hu, PhD, Department of Clinical Nutrition/Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing 400010, China.
E-mail: [email protected]

    As part of AP&T's peer-review process, a technical check of this meta-analysis was performed by Dr Y. Yuan. This article was accepted for publication after full peer-review.

    Fen Liu and Xi-Wei Wang contributed equally to this work.


Summary
Background

The seroclearance of hepatitis B surface antigen (HBsAg) in patients with chronic hepatitis B (CHB) is considered to be associated with favourable clinical outcomes. However, previous studies with inconsistent findings reported that hepatocellular carcinoma (HCC) could still develop in those patients.
Aim

To establish the proportion of HCC occurrence in CHB patients after HBsAg seroclearance, a systematic review and meta-analysis was performed.
Methods

Databases of Medline, Web of Science and Embase were searched from inception to July 2015. The proportion of patients who developed HCC after HBsAg seroclearance was pooled by a random-effects model.
Results

Twenty-eight studies were finally included, involving 34 952 patients with HBsAg seroclearance. The overall pooled proportion suggested that 2.29% (95% CI: 1.19–4.37%) CHB patients would develop HCC despite HBsAg seroclearance. In HBsAg seroclearance patients without cirrhosis and HCV co-infection, the pooled proportion of HCC development was 1.55% (95% CI: 0.92–2.61%). Moreover, patients with cirrhosis or age greater than 50 years at the time of HBsAg seroclearance were at significantly higher risk for HCC development. Nonetheless, the seroclearance of HBsAg was significantly associated with a reduced risk for HCC compared with persistently positive HBsAg (RR = 0.34, 95% CI: 0.20–0.56, P < 0.001).
Conclusions

Despite that HBsAg seroclearance can significantly reduce the risk for HCC, HCC can still develop in a proportion of CHB patient after HBsAg seroclearance. Closer attention should be paid to those patients with established cirrhosis or older age than 50 years at the time of HBsAg seroclearance.

StephenW

系统评价与Meta分析：慢性乙型肝炎患者的乙肝表面抗原血清学清除肝癌的发展

    F. Liu1，X.-W. Wang1，L. Chen1,2，P. HU1，H REN1 andH.-D. Hu1,2，*

文章首次在线发表时间：2016年4月27日

DOI：10.1111 / apt.13634

2016年©约翰·威利父子有限公司

问题

消化系统药理学和治疗

第43卷第12期，页1253至1261年，2016年6月
制品具有为2的altmetric得分

    传染病分子生物学重点实验室，感染科，研究所病毒性肝炎，重庆医科大学附属第二医院，重庆，中国
    临床营养学系，重庆医科大学，重庆，中国第二附属医院

*通讯作者：
H.-D.博士胡锦涛，博士，临床营养/传染科，重庆医科大学，76号，临江路，重庆市渝中区，重庆400010，中国第二附属医院。
电子信箱：[email protected]

    由于AP＆T的同行评审过程的一部分，这一荟萃分析的技术检查被Y.袁博士执行。这篇文章被接受后满同行评审的出版物。

    刘芬和西王炜同等贡献这项工作。


概要
背景

在慢性乙型肝炎（CHB）乙肝表面抗原（HBsAg）的血清清除被认为是具有有利的临床结果相关联。然而，随着不一致的结果先前的研究报道，肝细胞癌（HCC）可以在这些患者仍然发展。
目标

要建立的HBsAg血清清除后HCC发生的慢性乙型肝炎患者的比例，进行了系统回顾和荟萃分析。
方法

医学，科学和医学文摘的网络数据库，从开始搜查，以2015年七月患者谁开发后HCC转阴乙肝表面抗原是由随机效应模型合并的比例。
结果

二十八个研究，最终纳入，涉及34 952例乙肝表面抗原血清学清除。总的汇集比例表明，2.29％（95％CI：1.19-4.37％）慢性乙肝患者会发展HCC尽管乙肝表面抗原血清学清除。在乙肝表面抗原血清学清除患者无肝硬化和HCV合并感染，肝癌发展的合并比例为1.55％（95％CI：0.92-2.61％）。此外，患者与乙肝表面抗原血清学清除的时间肝硬化或年龄超过50岁以上的人肝癌开发风险显著较高。 （：0.20-0.56，p <0.001 RR = 0.34，95％CI）尽管如此，HBsAg的血清清除与肝癌的风险降低，利用持续HBsAg阳性相比被显著相关联。
结论

尽管乙肝表面抗原血清学清除可显著降低肝癌的风险，肝癌还是可以发展CHB患者HBsAg的血清学清除后的比例。言归正传要注意那些确诊的肝硬化或年龄比乙肝表面抗原血清学清除的时间50年。

儒者也

这么多！34952例表面抗原血清转换的病例，是怎么收集到的？

儒者也

表面抗原血清转换，毕竟大大降低了HCC发生率。
尽量避免肝硬化，可以降低HCC发生率。

StephenW

儒者也 发表于 2016-5-17 10:51
这么多！34952例表面抗原血清转换的病例，是怎么收集到的？

从不同发表的研究报告 (这是一个meta分析).