降低肝癌的风险与慢性乙型肝炎患者的正常的轻度升高ALT和

StephenW

Medicine (Baltimore). 2016 Aug;95(31):e4433. doi: 10.1097/MD.0000000000004433.
Lower liver cancer risk with antiviral therapy in chronic hepatitis B patients with normal to minimally elevated ALT and no cirrhosis.Hoang JK1, Yang HI, Le A, Nguyen NH, Lin D, Vu VD, Chaung K, Nguyen V, Trinh HN, Li J, Zhang JQ, Chen CJ, Nguyen MH.
Author information

• 1aDivision of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA bGenomics Research Center, Academia Sinica cInstitute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan dStanford Cancer Institute, Stanford Medicine, Stanford eDepartment of Internal Medicine, University of California, San Diego fDepartment of Medicine, Stanford University Medical Center, Stanford gSan Jose Gastroenterology, San Jose hGastroenterology, Palo Alto Medical Foundation, Mountain View iPrimary Care, Chinese Hospital, San Francisco, California, USA jGraduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
  

AbstractFor chronic hepatitis B (CHB), alanine aminotransferase (ALT) ≥2 × upper limit of normal (ULN) is often used as a major criteria to initiate treatment in absence of cirrhosis, though patients with lower ALT may not be free from future risk of hepatocellular carcinoma (HCC). We aimed to examine the effect of antiviral therapy on HCC incidence based on ALT levels.We performed a retrospective study on 3665 patients consisting of United States and Taiwanese REVEAL-HBV cohort who were consecutive, treatment-naïve, noncirrhotic CHB patients aged ≥40 years. Patients were categorized by ALT cutoffs (≥2 × ULN vs <2 × ULN) and subgrouped by treatment status. Kaplan-Meier and Cox proportional hazards models were used to calculate cumulative incidence and hazard ratio (HR) of HCC adjusting for REACH-B scores.A total of 202 patients developed HCC. Antiviral treatment significantly reduced HCC risk: HR 0.24, 95% confidence interval 0.10-0.58; P = 0.001. HCC incidence per 100,000 person-years was significantly higher in untreated versus treated patients, even for those with ALT < 2 × ULN: 314.46 versus 0 per 100,000 person-years, P = 0.0042. For patients with Hepatitis B Virus (HBV) Deoxyribonucleic Acid (DNA) ≥ 2000 IU/mL, the number-needed-to-treat (NNT) were 15 and 14 to prevent 1 incident HCC at year 10 for patients with ALT < 2 × ULN and ≥2 × ULN, respectively.After adjustment by REACH-B score, antiviral treatment significantly decreased HCC incidence even in patients with ALT < 2 × ULN. NNT to prevent 1 incident HCC after 10 years of therapy was low (14-15) in patients with mildly elevated HBV DNA ≥ 2000 IU/mL regardless of ALT levels.


PMID:27495067DOI:10.1097/MD.0000000000004433

StephenW

医学（巴尔的摩）。 2016年八月; 95（31）：e4433。 DOI：10.1097 / MD.0000000000004433。
降低肝癌的风险与慢性乙型肝炎患者的正常的轻度升高ALT和肝硬化无抗病毒治疗。
晃JK1，杨喜，乐A，阮NH，林D，武VD，羌K，阮V，郑氏HN，李江，张JQ，陈CJ，阮MH。
作者信息

    胃肠病学和肝病，斯坦福大学医学中心，斯坦福大学，美国加利福尼亚州bGenomics研究中心，临床医学中央研究院cInstitute，国立阳明大学，台湾台北dStanford癌症研究所，斯坦福大学医学院内科，大学斯坦福eDepartment的1aDivision加州，医学圣地亚哥fDepartment，斯坦福大学医学中心，斯坦福吉成何塞消化内科，圣何塞hGastroenterology，帕洛阿尔托医学基金会，山景IPRIMARY护理，中国医院，旧金山，加利福尼亚州，流行病学美国jGraduate研究所与预防医学，国立台湾大学，台北，台湾。

抽象

对慢性乙型肝炎（CHB），丙氨酸转氨酶（ALT）≥2×标准上限（ULN）的上限被经常用作主要标准在不存在肝硬化来启动治疗，虽然患者下ALT可能无法从未来风险自由肝细胞癌（HCC）。我们的目的是考察的基础上ALT levels.We抗病毒治疗对肝癌发生率的影响在由美国和台湾的3665例患者进行的回顾性研究REVEAL-HBV队列谁是连续的，治疗初治，肝硬化的慢性乙肝患者年龄≥40年。患者通过ALT临界值（≥2×ULN VS <2×ULN）分类及治疗现状subgrouped。 Kaplan-Meier法和Cox比例风险模型被用来计算累积发病率和肝癌调整REACH-B scores.A共发生HCC 202例危险比（HR）。抗病毒治疗显著降低肝癌风险：HR 0.24,95％置信区间0.10-0.58; P = 0.001。每10万人年HCC发生率与未经治疗的患者显著高，即使是对那些与ALT <2×ULN：314.46和0每10万人年，P = 0.0042。对于患有乙型肝炎病毒（HBV）脱氧核糖核酸（DNA）≥2000 IU / mL时，所需要的性治疗数（NNT）分别为15和14，以防止1事件HCC在今年10例ALT <2× ULN和≥2×ULN，respectively.After调整由REACH-B的分数，抗病毒治疗与显著ALT <2×ULN降低肝癌发病率甚至在病人。 NNT防止事故1 HCC经过10年的治疗率较低（14-15）的患者轻度升高的HBV DNA≥2000国际单位/毫升，无论ALT水平。

结论：
    27495067
DOI：
    10.1097 / MD.0000000000004433