慢性乙型肝炎免疫耐受相关的肝细胞癌和死亡风险高

StephenW

Hepatology
Original Article
High risk of hepatocellular carcinoma and death in patients with immune-tolerant-phase chronic hepatitis B

    Gi-Ae Kim1, Young-Suk Lim2, Seungbong Han3, Jonggi Choi2, Ju Hyun Shim2, Kang Mo Kim2, Han Chu Lee2, Yung Sang Lee2

Author affiliations
Abstract

Objective High serum HBV DNA levels are associated with high risks of hepatocellular carcinoma (HCC) and cirrhosis in patients with chronic hepatitis B (CHB). Although the immune-tolerant (IT) phase is characterised by high circulating HBV DNA levels, it remains unknown whether antiviral treatment reduces risks of HCC and mortality.

Design This historical cohort study included HBeAg-positive patients with CHB with high HBV DNA levels (≥20 000 IU/mL) and no evidence of cirrhosis at a tertiary referral hospital in Korea from 2000 to 2013. The clinical outcomes of 413 untreated IT-phase patients with normal alanine aminotransferase (ALT) levels (females, <19 IU/mL; males, <30 IU/mL) were compared with those of 1497 immune-active (IA)-phase patients (ALT ≥80 IU/mL) treated with nucleos(t)ide analogues.

Results The IT group was significantly younger than the IA group (mean age, 38 vs 40 years at baseline, p=0.04). The 10-year estimated cumulative incidences of HCC (12.7% vs 6.1%; p=0.001) and death/transplantation (9.7% vs 3.4%; p<0.001) were significantly higher in the IT group than the IA group. In multivariable analyses, the IT group showed a significantly higher risk of HCC (HR 2.54; 95% CI 1.54 to 4.18) and death/transplantation (HR 3.38; 95% CI 1.85 to 6.16) than the IA group, which was consistently identified through inverse probability treatment weighting, propensity score-matched and competing risks analyses.

Conclusions Untreated IT-phase patients with CHB had higher risks of HCC and death/transplantation than treated IA-phase patients. Unnecessary deaths could be prevented through earlier antiviral intervention in select IT-phase patients.

http://dx.doi.org/10.1136/gutjnl-2017-314904

StephenW

肝病
来源文章
慢性乙型肝炎免疫耐受相关的肝细胞癌和死亡风险高

    Gi-Ae Kim1，Young-Suk Lim2，Seungbong Han3，Choong Jung2，Ju Hyun Shim2，Kim Kang Kim2，Han Chu Lee2，Yung Sang Lee2

作者从属关系
抽象

目的高血清HBV DNA水平与慢性乙型肝炎（CHB）患者肝细胞癌（HCC）和肝硬化风险高有关。虽然免疫耐受（IT）阶段的特点是循环HBV DNA水平高，但是抗病毒治疗是否降低HCC发病风险和死亡率还不清楚。

设计这项历史性队列研究包括2000年至2013年在韩国的一家三级转诊医院的HBeAg阳性CHB患者，其HBV DNA水平高（≥20000 IU / mL），无肝硬化证据。413例未经治疗的IT- （ALT≥80IU/ mL）的1497例正常丙氨酸转氨酶（ALT）水平的患者（女性<19IU / mL;男性<30IU /用核苷（酸）类似物处理。

结果IT组明显比IA组年龄小（平均年龄38岁，基线40岁，p = 0.04）。 IT组的10年估计累积发生率（12.7％比6.1％; p = 0.001）和死亡/移植（9.7％比3.4％; p <0.001）显着高于IA组。在多变量分析中，IT组显示出比IA组显着更高的HCC风险（HR 2.54; 95％CI 1.54至4.18）和死亡/移植（HR 3.38; 95％CI 1.85至6.16）反概率处理加权，倾向分数匹配和竞争风险分析。

结论未经治疗的IT阶段CHB患者HCC和死亡/移植的风险高于治疗的IA阶段患者。在选择的IT阶段患者中通过早期的抗病毒干预可以预防不必要的死亡。

antiHBVren

年纪大的DNA水平高也应该抗病毒，抗病毒的利大于弊，减少HCC发生率

neilhbver

逻辑不是很能说明问题，it组应该区分是否抗病毒，内部进行对比。而不是跟ia组比。ia已经激活免疫了，不能说明抗病毒是否降低了hcc几率

StephenW

回复 neilhbver 的帖子

我认为IT（免疫耐受）组也应该分层年龄组，并进行比较。
这可能确定IT的高风险组.