低水平的病毒血症和接受恩替卡韦治疗的患者中肝细胞癌的

StephenW

Hepatology. 2016 Nov 5. doi: 10.1002/hep.28916. [Epub ahead of print]
Low-level viremia and the increased risk of hepatocellular carcinoma in patients receiving entecavir treatment.
Kim JH1, Sinn DH1, Kang W1, Gwak GY1, Paik YH1, Choi MS1, Lee JH1, Koh KC1, Paik SW1.
Author information

    1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Abstract

The long-term clinical impact of low-level viremia (LLV; <2,000 IU/mL) is not well understood. As a result, it is unclear whether the development of LLV during entecavir monotherapy requires a change in therapy. A retrospective cohort of 875 treatment-naive chronic hepatitis B virus (HBV) monoinfected patients (mean age 47.7 years, male = 564 [65.5%], cirrhosis = 443 [50.6%]) who received entecavir monotherapy were analyzed for the development of hepatocellular carcinoma (HCC). The HCC risk was compared between patients who maintained virological response (MVR), defined by persistently undetectable HBV DNA (<12 IU/mL), and patients who experienced LLV, defined by either persistent or intermittent episodes of <2,000 IU/mL detectable HBV DNA. During a median 4.5 years of follow-up (range 1.0-8.7 years), HCC was diagnosed in 85 patients (9.7%). HCC developed more frequently in patients who experienced LLV than MVR (14.3% versus 7.5% at 5 years, P = 0.015). The hazard ratio comparing those with LLV to MVR was 1.98 (95% confidence interval = 1.28-3.06, P = 0.002, adjusted for age, sex, hepatitis B e antigen, baseline HBV DNA levels, and cirrhosis). Among patients with cirrhosis, those with LLV exhibited a significantly higher HCC risk than those with MVR (HCC incidence rate at 5 years 23.4% versus 10.3%, adjusted hazard ratio = 2.20, 95% confidence interval 1.34-3.60; P = 0.002). However, for patients without cirrhosis, there was no significant difference in the HCC risk between LLV and MVR.
CONCLUSION:

LLV observed during entecavir monotherapy was associated with a higher risk of HCC, especially for those with cirrhosis, indicating that LLV during potent antiviral therapy is consequential. (Hepatology 2017).

© 2016 by the American Association for the Study of Liver Diseases.

PMID:
    28012257
DOI:
    10.1002/hep.28916

    [PubMed - as supplied by publisher]

StephenW

肝脏病学。 2016 Nov 5. doi：10.1002 / hep.28916。 [打印前的电子版]
低水平的病毒血症和接受恩替卡韦治疗的患者中肝细胞癌的风险增加。
Kim JH1，Sinn DH1，Kang W1，​​Gwak GY1，Paik YH1，Choi MS1，Lee JH1，Koh KC1，Paik SW1。
作者信息

    医学部，三星医疗中心，Sungkyunkwan大学医学院，韩国首尔，韩国。

抽象

低水平病毒血症（LLV; <2,000 IU / mL）的长期临床影响尚不清楚。因此，尚不清楚在恩替卡韦单药治疗期间LLV的发展是否需要治疗的变化。接受恩替卡韦单药治疗的875例初治慢性乙型肝炎病毒（HBV）单一感染患者（平均年龄47.7岁，男性= 564 [65.5％]，肝硬化= 443 [50.6％]）的回顾性队列分析肝细胞癌（HCC）。在维持病毒学应答（MVR）的患者（通过持续不可检测的HBV DNA（<12IU / mL））和经历LLV的患者之间比较HCC风险，所述LLV由持续或间歇性发作的<2,000IU / mL可检测的HBV脱氧核糖核酸。在中位4.5年的随访（范围为1.0-8.7岁）中，HCC被诊断为85例（9.7％）。 HCC在经历LLV比MVR的患者中更频繁地发展（14.3％对5年时的7.5％，P = 0.015）。与LLV和MVR比较的风险比为1.98（95％置信区间= 1.28-3.06，P = 0.002，根据年龄，性别，乙型肝炎e抗原，基线HBV DNA水平和肝硬化调整）。在肝硬化患者中，具有LLV的患者的HCC风险显着高于MVR（HCC发生率在5年时23.4％对10.3％，调整的风险比= 2.20,95％置信区间1.34-3.60; P = 0.002）。然而，对于没有肝硬化的患者，LLV和MVR之间的HCC风险没有显着差异。
结论：

在恩替卡韦单药治疗期间观察到的LLV与肝癌的高风险相关，特别是对于具有肝硬化的患者，表明强效抗病毒治疗期间的LLV是相应的。 （Hepatology2017）。

©2016美国肝病研究协会。

PMID：
    28012257
DOI：
    10.1002 / hep.28916

    [PubMed - 由出版商提供]

商业战士

LLV就是抗病毒后，DNA总是不能转阴，维持在2000左右？

StephenW

回复 商业战士 的帖子

是.维持在2000下.