中国慢性乙型肝炎病毒感染患者长期抗病毒治疗后肝癌的发

StephenW

Clin Res Hepatol Gastroenterol. 2017 Feb 22. pii: S2210-7401(16)30200-5. doi: 10.1016/j.clinre.2016.11.007. [Epub ahead of print]
The development of hepatocarcinoma after long-term antivirus treatment of Chinese patients with chronic hepatitis B virus infection: Incidence, long-term outcomes and predictive factors.Li ZQ1, Hu CL2, Yu P3, Gu XY2, Zhang JJ2, Li H2, Zhang HY2, Lv J2, Liu YM2, Zeng QL2, Yan JY4, Yu ZJ2, Zhang Y5.
Author information

• 1Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China; Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China.
• 2Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China.
• 3Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China.
• 4Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China. Electronic address: [email protected].
• 5Department of infectious disease, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China; Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China; Department of Oncology, the First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China; School of Life Sciences, Zhengzhou University, 450052 Zhengzhou, Henan, China; Key Laboratory of Clinical-Medicine, the First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China.
  

AbstractBACKGROUND: Patients with chronic hepatitis B virus (HBV) infection are at high risk for progressing to decompensated cirrhosis and hepatocellular carcinoma (HCC). Although long-term treatment with nucleos(t)ide analogues (NAs) benefits patients with chronic hepatitis B (CHB), many develop HCC. Therefore, the clinical outcomes of patients CHB who undergo long-term treatment with NAs remain to be identified. The aim of this study therefore was to evaluate the risk and predictors of patients with CHB who develop hepatitis B-induced HCC.
METHODS: We investigated 1200 patients with CHB who were treated with NAs for at least four years and evaluated the association of the variables ALT, HBsAg, HBV DNA, age and platelet count with the occurrence of HCC. We used multivariable analysis to identify independent risk factors for the development of HCC.
RESULTS: HCC developed in 153 NA-treated patients. Serum HBV DNA levels of 18.17% (218/1200) patients were>2000IU/mL. The median level of liver stiffness measurement (LSM) of all patients was 8.3±6.7kPa vs. 19.8±10.1kPa in patients with HCC. Advanced age, lower platelet counts, positive HBV DNA load, lower ALB concentration and relatively advanced liver disease were associated with an increased risk of developing HCC. Further, TGF-β and IFN-γ levels were higher and lower in patients with HCC or CHB, respectively.
CONCLUSIONS: Hepato-carcinogenesis occurred more frequently in patients with a positive HBV DNA load and relatively advanced liver disease. Therefore, it is important to administer antiviral therapy to patients with CHB before they develop HBV-related cirrhosis.

Copyright © 2017 Elsevier Masson SAS. All rights reserved.

PMID:28237828DOI:10.1016/j.clinre.2016.11.007

StephenW

Clin Res Hepatol Gastroenterol。 2017 Feb 22. pii：S2210-7401（16）30200-5。 doi：10.1016 / j.clinre.2016.11.007。 [打印前的电子版]
中国慢性乙型肝炎病毒感染患者长期抗病毒治疗后肝癌的发展：发生率，长期结局和预测因素。
Li ZQ1，Hu CL2，Yu P3，Gu XY2，Zhang JJ2，Li H2，Zhang HY2，Lv J2，Liu YM2，Zeng QL2，Yan JY4，Yu ZJ2，Zhang Y5。
作者信息

    1郑​​州大学第一附属医院传染病科，450052郑州，河南;郑州大学第一附属医院生物治疗中心，450052郑州，河南。
    2郑州大学第一附属医院感染病部，450052郑州，河南。
    郑州大学第一附属医院3Biotherapy Center，450052郑州，河南。
    郑州大学第一附属医院感染病室，450052郑州，河南。电子地址：[email protected]。
    郑州大学第一附属医院传染病科，450052郑州，河南;郑州大学第一附属医院生物治疗中心，450052郑州，河南;郑州大学第一附属医院肿瘤科，450052郑州，河南;郑州大学生命科学学院，450052郑州，河南;郑州大学第一附属医院临床医学重点实验室，450052郑州，河南。

抽象
背景：

慢性乙型肝炎病毒（HBV）感染的患者具有进展到代偿失调性肝硬化和肝细胞癌（HCC）的高风险。虽然用核苷（t）ide类似物（NA）的长期治疗有益于慢性乙型肝炎（CHB）患者，但许多发展HCC。因此，使用NA进行长期治疗的CHB患者的临床结果仍有待确定。因此，本研究的目的是评估CHB患者发展乙型肝炎诱导的HCC的风险和预测因素。
方法：

我们调查1200名CHB患者至少四年接受NAs治疗，并评估变量ALT，HBsAg，HBV DNA，年龄和血小板计数与HCC发生的关联。我们使用多变量分析来确定HCC发展的独立危险因素。
结果：

HCC在153例NA治疗的患者中发展。 18.17％（218/1200）患者的血清HBV DNA水平> 2000IU / mL。所有患者肝硬度测量（LSM）的中位数水平为8.3±6.7kPa，而HCC患者为19.8±10.1kPa。高级年龄，较低的血小板计数，阳性HBV DNA负荷，较低的ALB浓度和相对晚期的肝病与增加的发展HCC的风险相关。此外，TGF-β和IFN-γ水平分别在HCC或CHB患者中更高和更低。
结论：

在HBV DNA负荷阳性和肝病相对严重的患者中，肝癌发生的频率更高。因此，重要的是，在发生HBV相关肝硬化之前对CHB患者施用抗病毒治疗。

版权所有©2017 Elsevier Masson SAS。版权所有。

PMID：
    28237828
DOI：
    10.1016 / j.clinre.2016.11.007