对于具有基因型C型乙型肝炎病毒的HBeAg阳性慢性感染的成人

StephenW

J Infect Dis. 2017 Sep 23. doi: 10.1093/infdis/jix506. [Epub ahead of print]
Nucleos(t)ide Analogue Treatment for Adult Patients with HBeAg-positive Chronic Infection with Genotype C Hepatitis B Virus: A Nationwide Real-life Study.Chang Y1, Choe WH2, Sinn DH3, Lee JH1, Ahn SH4, Lee H4, Shim JJ5, Jun DW6, Park SY7, Nam JY1, Cho EJ1, Yu SJ1, Lee DH8, Lee JM8, Kim YJ1, Kwon SY2, Paik SW3, Yoon JH1.
Author information
1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.2Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.3Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.5Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.6Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.7Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.8Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.

AbstractBackground/Aim: Antiviral treatment for patients in HBeAg-positive chronic hepatitis B virus (HBV) infection is still controversial. We assessed whether antiviral treatment reduces liver disease progression in those patients.
Methods: This study included consecutive patients that tested positive for HBeAg with an HBV DNA >20,000 IU/mL, ALT <40 IU/L and without evidence of cirrhosis in eight large-volume hospitals in Korea. The primary endpoint was the development of hepatocellular carcinoma (HCC) and the secondary endpoint was the development of cirrhosis.
Results: A total of 484 patients were included: 87 in the antiviral treatment group and 397 in the control group. Baseline liver function was significantly more favorable for the control group. After matching for propensity score to overcome those differences, the antiviral treatment group had significantly reduced risk for HCC (hazard ratio [HR]=0.234, log-rank P=0.046) and cirrhosis (HR=0.235, log-rank P=0.015) compared with the control group. After balancing the baseline characteristics using inverse probability weighting, antiviral therapy significantly decreased the risk of HCC (HR=0.189, log-rank P=0.004) and cirrhosis (HR=0.347, log-rank P=0.036).
Conclusion: Antiviral therapy for patients in HBeAg-positive chronic HBV infection with high viral load reduces the risk of HCC, even if the ALT levels are below the upper limit of normal.


KEYWORDS: Antiviral treatment; Hepatocellular carcinoma; Immune-tolerant phase; Liver cirrhosis

PMID:29029102DOI:10.1093/infdis/jix506

StephenW

J Infect Dis。 2017年9月23日。doi：10.1093 / infdis / jix506。 [提前印刷]
对于具有基因型C型乙型肝炎病毒的HBeAg阳性慢性感染的成人患者的核素（I）模拟治疗：全国现实生活研究。
Chang Y1，Choe WH2，Sinn DH3，Lee JH1，Ahn SH4，Lee H4，Shim JJ5，Jun DW6，Park SY7，Nam JY1，Cho EJ1，Yu SJ1，Lee DH8，Lee JM8，Kim YJ1，Kwon SY2，Paik SW3 ，尹JH1。
作者信息

1
    韩国首尔国立大学医学院内科和肝脏研究所。
2
    韩国首尔市Konkuk大学医学院内科系。
3
    韩国首尔Sungkyunkwan大学医学院三星医学中心医学系。
4
    延世大学医学院内科系，韩国首尔。
五
    韩国首尔京兴大学医学部内科系。
6
    韩阳医科大学内分泌科，韩国首尔。
7
    韩国大邱庆北国立大学医院内科系。
8
    韩国首尔国立大学医学院放射科。

抽象
背景/目的：

HBeAg阳性慢性乙型肝炎病毒（HBV）感染患者的抗病毒治疗仍有争议。我们评估了抗病毒治疗是否减少了这些患者的肝脏疾病进展。
方法：

这项研究包括在韩国8家大型医院中HBV DNA> 20,000 IU / mL，ALT <40 IU / L，无肝硬化证据的HBeAg阳性患者。主要终点是肝细胞癌（HCC）的发展，次要终点是肝硬化的发展。
结果：

共纳入484例患者：抗病毒治疗组87例，对照组397例。基线肝功能显着优于对照组。在匹配倾向评分以克服这些差异后，抗病毒治疗组显着降低HCC风险（风险比[HR] = 0.234，对数秩P = 0.046）和肝硬化（HR = 0.235，对数秩P = 0.015）与对照组比较。在使用逆概率加权平衡基线特征后，抗病毒治疗显着降低了HCC的风险（HR = 0.189，log-rank P = 0.004）和肝硬化（HR = 0.347，log-rank P = 0.036）。
结论：

具有高病毒载量的HBeAg阳性慢性HBV感染患者的抗病毒治疗降低了HCC的风险，即使ALT水平低于正常上限。
关键词：

抗病毒治疗;肝细胞癌;免疫耐受期;肝硬化

结论：
    29029102
DOI：
    10.1093 / infdis / jix506