高BMI与HBV血清清除病例中的HCC发病率相关

StephenW

High BMI linked to HCC incidence in HBV seroclearance cases

Song C, et al. Clin Gastroenterol Hepatol. 2018;doi:10.1016/j.cgh.2018.08.019.
September 17, 2018

Analysis of hepatocellular carcinoma risk factors among patients with varying hepatitis B surface antigen status showed that higher BMI was a risk factor among those with HBsAg seroclearance compared with those with persistent HBsAg positivity.

“Hepatitis B surface antigen (HBsAg) seroclearance is considered to be one of the most important endpoints of chronic HBV infection and is associated with a reduced risk of HCC,” Ci Song, MD, from Nanjing Medical University in China, and colleagues wrote.

To evaluate the relationship between HBsAg status and HCC incidence, Song and colleagues conducted a population-based cohort study that included 652 patients with HBsAg seroclearance, 2,983 patients with persistent HBsAg and 33,920 patients who were negative for HBsAg.

Between April 2007 and November 2016, the researchers performed follow-up investigations every 6 months. The cumulative HCC incidence rate was 19.8 per 100,000 person-years. This was significantly lower than the rate in patients with persistent HBsAg (179.3 per 100,000 person-years; P < .001) and slightly higher than the rate in patients negative for HBsAg (6.81 per 100,000 person-years; P = .012).

Among patients with persistent HBsAg, men (HR = 2.83; 95% CI, 2.06-3.89), older patients (HR = 1.43; 95% CI, 1.08-1.9), those with a history of cancer (HR = 1.73; 95% CI 1.35-2.22), and those with alanine aminotransferase higher than 40 U/L (HR = 2.02; 95% CI, 1.14-2.89) or alpha-fetoprotein lower than 20 (HR = 10.92; 95% CI, 7.2-15.9) at baseline had significantly higher risk for HCC.

In contrast, the above predictors did not correlate with HCC risk in patients who achieved spontaneous HBsAg seroclearance. The factor associated with higher HCC risk in HBsAg seroclearance cases was BMI of 25 kg/m2 or higher (HR = 9.32; 95% CI, 1.11-78.08). Additionally, the incidence rate of fatty liver was higher in patients with HCC and HBsAg seroclearance compared with patients with HCC and persistent HBsAg (RR= 28.21; P = .049).

“Based on the above characteristic difference, we speculate that the carcinogenic mechanism among patients with HBsAg seroclearance was different from HBsAg-persistent carriers,” the researchers wrote. “For HBsAg-persistent carriers, HBV infection was the major driver factor of HCC. After HBsAg seroclearance, metabolic disease (obesity or fatty disease) may play a role in liver tumorigenesis.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.

StephenW

高BMI与HBV血清清除病例中的HCC发病率相关

Song C，et al。 Clin Gastroenterol Hepatol。 2018; DOI：10.1016 / j.cgh.2018.08.019。
2018年9月17日

不同乙型肝炎表面抗原状态患者的肝细胞癌危险因素分析显示，与持续HBsAg阳性的患者相比，HBsAg血清清除率较高的BMI是危险因素。

“乙型肝炎表面抗原（HBsAg）血清清除被认为是慢性HBV感染最重要的终点之一，并且与降低HCC风险有关，”来自中国南京医科大学的Ci Song医师及其同事写道。

为了评估HBsAg状态与HCC发病率之间的关系，Song及其同事进行了一项基于人群的队列研究，其中包括652例HBsAg血清清除患者，2,983例持续性HBsAg患者和33,920例HBsAg阴性患者。

2007年4月至2016年11月期间，研究人员每6个月进行一次随访调查。累计HCC发病率为每10万人年19.8。这显着低于持续性HBsAg患者的发生率（每100,000人年179.3; P <.001），略高于HBsAg阴性患者的发生率（每100,000人年6.81例; P = .012）。

在持续性HBsAg患者中，男性（HR = 2.83; 95％CI，2.06-3.89），老年患者（HR = 1.43; 95％CI，1.08-1.9），有癌症病史者（HR = 1.73; 95％） CI 1.35-2.22），丙氨酸氨基转移酶高于40 U / L（HR = 2.02; 95％CI，1.14-2.89）或甲胎蛋白低于20（HR = 10.92; 95％CI，7.2-15.9）在基线时，HCC的风险显着增加。

相反，上述预测因子与实现自发性HBsAg血清清除的患者的HCC风险无关。与HBsAg血清清除病例中较高的HCC风险相关的因素是BMI为25 kg / m2或更高（HR = 9.32; 95％CI，1.11-78.08）。此外，与HCC和持续性HBsAg患者相比，HCC和HBsAg血清清除患者的脂肪肝发病率更高（RR = 28.21; P = .049）。

“基于上述特征差异，我们推测HBsAg血清清除患者的致癌机制与HBsAg持续携带者不同，”研究人员写道。 “对于HBsAg持续携带者，HBV感染是HCC的主要驱动因素。 HBsAg血清清除后，代谢性疾病（肥胖或脂肪性疾病）可能在肝脏肿瘤发生中起作用。“ - 作者：Talitha Bennett

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