乙型肝炎相关失代偿期肝硬化患者的抗病毒治疗的长期结果

StephenW

World J Gastroenterol. 2018 Oct 28;24(40):4606-4614. doi: 10.3748/wjg.v24.i40.4606.
Long term outcome of antiviral therapy in patients with hepatitis B associated decompensated cirrhosis.
Ju YC1, Jun DW1, Choi J2, Saeed WK3, Lee HY3, Oh HW3.
Author information

1
    Department of Translational Medicine, Graduate school of Biomedical Science and Engineering, Hanyang University, Seoul 04763, South Korea.
2
    Department of Industrial Management Engineering, Korea University, Seoul 02841, South Korea.
3
    Department of Internal Medicine, School of Medicine, Hanyang University, Seoul 04763, South Korea.

Abstract
AIM:

To investigate survival rate and incidence of hepatocellular carcinoma (HCC) in patients with decompensated cirrhosis in the antiviral era.
METHODS:

We used the Korean Health Insurance Review and Assessment. Korea's health insurance system is a public single-payer system. The study population consisted of 286871 patients who were prescribed hepatitis B antiviral therapy for the first time between 2007 and 2014 in accordance with the insurance guidelines. Overall, 48365 antiviral treatment-naïve patients treated between 2008 and 2009 were included, and each had a follow-up period ≥ 5 years. Data were analyzed for the 1st decompensated chronic hepatitis B (CHB) and treatment-naïve patients (n = 7166).
RESULTS:

The mean patient age was 43.5 years. The annual mortality rates were 2.4%-19.1%, and 5-year cumulative mortality rate was 32.6% in 1st decompensated CHB treatment-naïve subjects. But the annual mortality rates sharply decreased to 3.4% (2.4%-4.9%, 2-5 year) after one year of antiviral treatment. Incidence of HCC at first year was 14.3%, the annual incidence of HCC decreased to 2.5% (1.8%-3.7%, 2-5 year) after one year. 5-year cumulative incidence of HCC was 24.1%. Recurrence rate of decompensated event was 46.9% at first year, but the annual incidence of second decompensation events in decompensated CHB treatment-naïve patients was 3.4% (2.1%-5.4%, 2-5 year) after one year antiviral treatment. 5-year cumulative recurrence rate of decompensated events was 60.6%. Meanwhile, 5-year cumulative mortality rate was 3.1%, and 5-year cumulative incidence of HCC was 11.5% in compensated CHB treatment-naïve patients.
CONCLUSION:

Long term outcome of decompensated cirrhosis treated with antiviral agent improved much, and incidence of hepatocellular carcinoma and mortality sharply decreased after one year treatment.
KEYWORDS:

Antiviral agent; Decompensated cirrhosis; Hepatitis B; Hepatocellular carcinoma; Mortality

PMID:
    30386110
PMCID:
    PMC6209577
DOI:
    10.3748/wjg.v24.i40.4606

StephenW

World J Gastroenterol。 2018年10月28日; 24（40）：4606-4614。 doi：10.3748 / wjg.v24.i40.4606。
乙型肝炎相关失代偿期肝硬化患者的抗病毒治疗的长期结果。
Ju YC1，Jun DW1，Choi J2，Saeed WK3，Lee HY3，Oh HW3。
作者信息

1
    汉阳大学生物医学科学与工程研究生院转化医学系，韩国首尔04763
2
    韩国大学工业管理工程系，韩国首尔02841。
3
    汉阳大学医学院内科，韩国首尔04763

抽象
目标：

调查抗病毒时代失代偿期肝硬化患者的肝细胞癌（HCC）的存活率和发病率。
方法：

我们使用了韩国健康保险审查和评估。韩国的医疗保险制度是一种公共单一付款制度。根据保险准则，研究人群包括286871名患者，他们在2007年至2014年间首次接受了乙型肝炎抗病毒治疗。总体而言，纳入了2008年至2009年期间接受治疗的48365例抗病毒治疗初治患者，每例患者的随访期均≥5年。分析第1代失代偿慢性乙型肝炎（CHB）和未治疗的患者（n = 7166）的数据。
结果：

患者的平均年龄为43.5岁。在第一次失代偿的CHB治疗初治受试者中，年死亡率为2.4％-19.1％，5年累积死亡率为32.6％。但经过一年的抗病毒治疗后，年死亡率急剧下降至3.4％（2.4％-4.9％，2 - 5年）。 HCC在第一年的发病率为14。3％，一年后HCC的年发病率下降至2.5％（1.8％-3.7％，2 - 5年）。 HCC的5年累积发病率为24.1％。失代偿期事件的复发率在第一年为46.9％，但在一年抗病毒治疗后，失代偿的CHB治疗初治患者的第二次失代偿事件的年发生率为3.4％（2.1％-5。4％，2 - 5年）。失代偿期事件的5年累积复发率为60.6％。同时，5年累积死亡率为3.1％，而补偿性CHB治疗初治患者的5年累积HCC发生率为11.5％。
结论：

用抗病毒剂治疗的失代偿期肝硬化的长期结果改善很多，并且治疗一年后肝细胞癌的发病率和死亡率急剧下降。
关键词：

抗病毒剂;失代偿性肝硬化;乙型肝炎;肝细胞癌;死亡

结论：
    30386110
PMCID：
    PMC6209577
DOI：
    10.3748 / wjg.v24.i40.4606