死于肝脏疾病和肝细胞癌在慢性乙型肝炎病毒感染患者的发

StephenW

Gastroenterol Hepatol (N Y). 2006 Jan;2(1):41-47.
Death From Liver Disease and Development of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B Virus Infection: A Prospective Study.Tong MJ1, Blatt LM1, Tyson KB1, Kao VW1.
Author information

• 1Dr. Tong is Chief at The Liver Center, Huntington Medical Research Institutes, Pasadena, Calif, where Dr. Tyson is a Research Scientist and Mr. Kao is a Research Associate. Dr. Tong is also the Director of Clinical Hepatology and Associate Director, Dumont-UCLA Liver Cancer Center at the Pfleger Liver Institute at the David Geffen School of Medicine at the University of California, Los Angeles. Dr. Blatt is Senior Vice President, Preclinical and Applied Research, at Intermune, Inc., in Brisbane, Calif.
  

AbstractBackground Patients with chronic hepatitis B virus (HBV) infection are at risk for death from complications of liver disease and development of hepatocellular carcinoma (HCC). To identify the time course and risk factors associated with these events, we conducted a prospective study in chronic hepatitis B patients referred to our clinic. Methods From January 1989 to March 1998, 400 hepatitis B surface antigen (HBsAg)-positive patients were classified into three categories: inactive carriers (N=110), chronic hepatitis (N=151), and cirrhosis (N=139). These patients were observed at 3- to 6-month intervals with liver tests, alpha-fetoprotein (AFP) levels, and ultrasound examinations. The study endpoints were death from liver disease complications and development of HCC. Results The patients were followed for a mean time (± SD) of 83.6 ± 39.6 months. During this period, no liver-related deaths or HCC were noted in inactive carriers. However, 38 of 139 (27.3%) patients with cirrhosis died from non-HCC-related liver complications. Multivariate analysis demonstrated that male sex (odds ratio [OR] 5.9; 95% confidence interval [CI], 2.0-22.6; P=.003), decreased initial serum albumin (OR 69.1; 95% CI, 11.5-486.4; P=.0009), low platelet count (OR 8.8; 95% CI, 0.96-92.9; P=.05), and presence of cirrhosis (OR 14.2; 95% CI, 3.4-111.8; P=.0009) were independently associated with increased mortality from chronic hepatitis B. During the same time period, nine of 151 (6.0%) chronic hepatitis patients and 22 of 139 (15.8%) patients with cirrhosis developed HCC. By multivariate analysis, progression to HCC was associated with advanced age (OR 19.7; 95% CI, 1.9-231.9; P=.01) and presence of cirrhosis (OR 3.6; 95% CI, 1.6-8.9; P=.003). Patients positive for hepatitis B early antigen (HBeAg) and HBeAg antibodies experienced liver-related deaths and developed HCC at similar rates. Conclusions This prospective study from the United States confirms previous observations of the high risk of mortality and development of HCC in patients infected with HBV. To decrease the risk of these complications, antiviral therapy should be initiated early in the course of the disease. In addition, surveillance for HCC must be performed at least every 6 months in patients with chronic hepatitis and cirrhosis.


KEYWORDS: Hepatitis B; chronic hepatitis; cirrhosis; hepatocellular carcinoma; inactive carriers; natural history

PMID:28210196

StephenW

胃肠素Hepatol（N Y）。 2006 Jan; 2（1）：41-47。
死于肝脏疾病和肝细胞癌在慢性乙型肝炎病毒感染患者的发展：前瞻性研究。
Tong MJ1，Blatt LM1，Tyson KB1，Kao VW1。
作者信息

1Dr。 Tong是肝脏中心主任，亨廷顿医学研究所，加利福尼亚州帕萨迪纳，其中Tyson博士是研究科学家，Kao先生是研究助理。唐博士还是临床肝病学主任，并在洛杉矶加利福尼亚大学David Geffen医学院的Pfleger肝脏研究所Dumont-UCLA肝癌中心副主任。 Blatt博士是位于加利福尼亚州布里斯班的Intermune公司的临床前和应用研究高级副总裁

抽象

背景慢性乙型肝炎病毒（HBV）感染的患者处于肝脏并发症和肝细胞癌（HCC）发展的死亡风险中。为了确定与这些事件相关的时间过程和风险因素，我们进行了前瞻性研究（HBsAg）阳性患者分为三类：非活动性携带者（N = 110），慢性肝炎（N = 151）和肝硬化= 139）。这些患者以3-至6个月的间隔观察，具有肝脏测试，甲胎蛋白（AFP）水平和超声检查。研究终点从肝脏疾病并发症和HCC的发展中被杀死。结果患者的平均随访时间（±SD）为83.6±39.6个月。在此期间，在非活动携带者中未发现肝相关死亡或HCC。然而，139个（27.3％）肝硬化患者中38个死于非-HCC相关维度。多变量分析：男性性别（OR = 5.9; 95％置信区间[CI]，2.0-22.6; P = .003），沉淀初始血清白蛋白（OR 69.1; 95％CI（OR 14.2; ，3.4-111.8; P = 0.0009），低血小板计数（OR 8.8; 95％CI，0.96-92.9; P = 0.05）和存在肝硬化.0009）与慢性乙型肝炎的死亡率增加独立相关。同期，151例（6.0％）慢性肝炎患者中的9例和139例（15.8％）肝硬化患者中22例发生HCC。通过多变量分析，HCC的进展与高龄（OR 19.7; 95％CI，1.9-231.9; P = 0.01）和存在肝硬化（OR 3.6; 95％CI，1.6-8.9; P = .003）早期抗原（HBeAg）和HBeAg抗体以比率经历肝相关死亡和发展HCC。结论美国的这项前瞻性研究证实了先前对HBV感染患者的死亡率和发展的高风险的观察结果。为了降低并发症的风险，应在疾病早期开始进行抗病毒治疗。此外，对于慢性肝炎和肝硬化患者，必须至少每6个月进行一次HCC监测。
关键词：

乙型肝炎;慢性肝炎;肝硬化肝细胞癌;

PMID：
28210196