慢性乙型肝炎低水平病毒血症患者的肝脏疾病严重程度和肝

StephenW

Non-invasive tests for liver disease severity and the hepatocellular carcinoma risk in chronic hepatitis B patients with low-level viremia

    Namyoung Paik, Dong H. Sinn*, Ji H. Lee, In S. Oh, Jung H. Kim, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon S. Choi, Joon H. Lee, Kwang C. Koh andSeung W. Paik

Version of Record online: 3 JUL 2017

DOI: 10.1111/liv.13489

© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Liver International

Volume 38, Issue 1, pages 68–75, January 2018
Article has an altmetric score of 7

    Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Email: Dong H. Sinn ([email protected])

* Correspondence
Dong Hyun Sinn, MD, PhD, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea.
Email: [email protected]

   
Keywords:

    hepatocellular carcinoma;low-level viremia;AST to platelet ratio index;fibrosis-4 score

Abstract
Background & 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 <2000 IU/mL).
Methods

A retrospective cohort of 1006 chronic hepatitis B patients showing persistently LLV, defined by at least two consecutive assessments in the year before enrolment, 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<.001). APRI at a cut-off of 0.5 was more specific but less sensitive for HCC development, and FIB-4 at a cut-off 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=1006, P<.001), respectively, and was 11.4%, 1.5% and 0.4% in the same respective order among non-cirrhotic patients (n=867, P<.001).
Conclusions

The combined use of two non-invasive serum biomarkers (APRI and FIB-4) could stratify HCC risk for chronic HBV-infected patients with LLV.

StephenW

慢性乙型肝炎低水平病毒血症患者的肝脏疾病严重程度和肝细胞癌风险的非侵入性检测

    Namyoung Paik，Dong H. Sinn *，Ji H. Lee，S. Oh，Jung H. Kim，Wonseok Kang，Geum-Youn Gwak，Yong-Han Paik，Moon S. Choi，Joon H. Lee，Kwang C. Koh和Seung W. Paik

在线记录版本：2017年7月3日

DOI：10.1111 / liv.13489

©2017 John Wiley＆Sons A / S。 John Wiley＆Sons Ltd出版

肝脏国际

卷38，第1期，第68-75页，2018年1月
文章的对等分数为7

    韩国首尔成均馆大学医学院三星医疗中心医学部

电邮：Dong H. Sinn（[email protected]）

*通信
韩国首尔江南区成均馆大学医学院三星医疗中心医学博士Dong Hyun Sinn博士。
电子邮件：[email protected]

   
关键词：

    肝细胞癌;低水平病毒血症; AST与血小板比值指数;纤维化-4评分

抽象
背景和目的

我们测试了肝脏疾病严重程度的非侵入性检测是否可以将显示低水平病毒血症（LLV，HBV DNA <2000 IU / mL）的慢性乙型肝炎病毒（HBV）感染患者的肝细胞癌（HCC）风险分层。
方法

对1006名慢性乙型肝炎患者进行回顾性队列研究，评估了入选前一年至少两次连续评估的LLV持续性LLV发生率。测试两种非侵入性血清生物标志物，天冬氨酸转氨酶与血小板比率指数（APRI）和纤维化-4（FIB-4）。超声定义为肝硬化。
结果

在平均5。1年的随访期间，36例患者发生HCC。肝硬化患者5年肝硬化发生率显着高于非肝硬化患者（19 / 139,13.7％），非肝硬化患者（17 / 867,2.0％，P <0.001）无显着性差异。 0.5的截止值的APRI更特异，但对HCC发展不太敏感，而FIB-4截止值1.45更敏感但特异性更低。当使用APRI和FIB-4对患者进行分组时，所有患者的5年累积HCC发病率分别为13.9％，1.4％和1.2％（APRI和FIB-4评分均为高， n = 1006，P <0.001），在非肝硬化患者中分别为11.4％，1.5％和0.4％（n = 867，P <0.001）。
结论

两种非侵入性血清生物标记物（APRI和FIB-4）的联合使用可以将慢性HBV感染LLV患者的HCC风险分层。