慢性乙型肝炎病毒血症患者肝脏疾病严重程度和肝细胞癌风

StephenW

Liver Int. 2017 Jun 5. doi: 10.1111/liv.13489. [Epub ahead of print]
Non-invasive tests for liver disease severity and the hepatocellular carcinoma risk in chronic hepatitis B patients with low level viremia.Paik N1, Sinn DH1, Lee JH1, Oh IS1, Kim JH1, 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, Korea.

AbstractBACKGROUND & AIMS: We tested whether non-invasive tests for liver disease severity can stratify hepatocellular carcinoma (HCC) risk in chronic hepatitis B virus (HBV) infected patients showing low level viremia (LLV, HBV DNA < 2,000 IU/mL).
METHODS: A retrospective cohort of 1,006 chronic hepatitis B patients showing persistently LLV, defined by at least two consecutive assessments in the year before enrollment, was assessed for HCC development. Two non-invasive serum biomarkers, the aspartate aminotransferase to platelet ratio index (APRI) and the Fibrosis-4 (FIB-4), were tested. Cirrhosis was defined with ultrasonography.
RESULTS: During a median 5.1 years of follow-up, HCC developed in 36 patients. HCC incidence rate at 5 years was significantly higher for cirrhotic patients (19/139, 13.7%), but was not null for non-cirrhotic patients (17/867, 2.0%, P < 0.001). APRI at a cutoff of 0.5 was more specific but less sensitive for HCC development, and FIB-4 at a cutoff of 1.45 was more sensitive but less specific. When both APRI and FIB-4 were used to group patients, the 5-year cumulative HCC incidence rate was 13.9%, 1.4% and 1.2% for both high, any high, and both low APRI and FIB-4 score among all patients (n = 1,006, P < 0.001), respectively, and was 11.4%, 1.5% and 0.4% in the same respective order among non-cirrhotic patients (n = 867, P < 0.001).
CONCLUSION: The combined use of two non-invasive serum biomarkers (APRI and FIB-4) could stratify HCC risk for chronic HBV infected patients with LLV. This article is protected by copyright. All rights reserved.


This article is protected by copyright. All rights reserved.



KEYWORDS: AST to platelet ratio index; Fibrosis-4 score; Hepatocellular carcinoma; Low level viremia

PMID:28581248DOI:10.1111/liv.13489

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StephenW

肝脏内2017年6月5日。doi：10.1111 / liv.13489。 [提前印刷]
慢性乙型肝炎病毒血症患者肝脏疾病严重程度和肝细胞癌风险的非侵入性检测。
Paik N1，Sinn DH1，Lee JH1，Oh IS1，Kim JH1，Kang W1，​​Gwak GY1，Paik YH1，Choi MS1，Lee JH1，Koh KC1，Paik SW1。
作者信息

1
    韩国首尔Sungkyunkwan大学医学院三星医学中心医学系。

抽象
背景与目的：

我们测试了肝脏疾病严重程度的非侵入性检测是否可以分级显示低水平病毒血症（LLV，HBV DNA <2,000 IU / mL）的慢性乙型肝炎病毒（HBV）感染患者的肝细胞癌（HCC）风险。
方法：

对1,006例慢性乙型肝炎患者进行回顾性研究，发现持续性LLV（入组前至少连续两次评估）定义为HCC发展。测试了两种非侵入性血清生物标志物，天冬氨酸转氨酶至血小板比指数（APRI）和纤维化-4（FIB-4）。肝硬化定义为超声检查。
结果：

在中位5.1年的随访中，HCC在36例患者中发展。 5年肝硬化发病率明显高于肝硬化患者（19/139,13.7％），非肝硬化患者（17/867，2.0％，P <0.001）为零。截止值为0.5的APRI对HCC发展较为具体但不太敏感，而在1.45的截止值下的FIB-4较敏感，但特异性较低。当APRI和FIB-4均用于分组患者时，所有患者中高，高，低APRI和FIB-4评分的5年累积HCC发生率分别为13.9％，1.4％和1.2％ n = 1,006，P <0.001），非肝硬化患者的相同顺序分别为11.4％，1.5％和0.4％（n = 867，P <0.001）。
结论：

联合使用两种非侵入性血清生物标志物（APRI和FIB-4）可以分层慢性HBV感染患者LLV的HCC风险。本文受版权保护。版权所有。

本文受版权保护。版权所有。
关键词：

AST至血小板比指数;纤维化4评分;肝细胞癌;低级病毒血症

结论：
    28581248
DOI：
    10.1111 / liv.13489