AASLD2018[2116]乙型肝炎核心相关抗原（HΒcrΑg） 是一种新的肝

StephenW

2116
Hepatitis B Core-Related Antigen (HΒcrΑg)
Is a Novel Risk Marker for Hepatocellular
Carcinoma during Nucleoside Analogue
Treatment
Hatsue Fujino, Department of Gastroenterology and
Metabolism, Hiroshima University and Kazuaki Chayama,
Department of Gastroenterology and Metabolism, Institute of
Biomedical & Health Science, Hiroshima University
Background: Patients infected with hepatitis B virus (HBV)
are at high risk of developing liver cirrhosis and hepatocellular
carcinoma (HCC). Although nucleos(t)ide analogues (NAs)
treatment has made it possible to control HBV chronic
liver diseases, risk of liver carcinogenesis still remains.
Recently, hepatitis B core-related antigen (HBcrAg) has been
reported as a serological marker for disease monitoring and
prognostication of chronic hepatitis B. We assessed risk
factors of HCC development in patients infected with HBV
during NAs therapy including HBcrAg. Methods: This study
included HBV infected patients induced NAs (Lamivudine,
Adefovir, Entecavir, Tenofovir) without HCC. The following
exclusion criteria were applied: 1) co-infected with hepatitis
C, or human immunodeficiency virus, 2) autoimmune
hepatitis, or primary biliary cholangitis, 3) acute liver failure
at first visit, 4) breakthrough hepatitis during the follow-up
period, 5) prevention for HBV reactivation, and 6) history of
hepatic transplantation. HBcrAg was measured before or
after the introduction of NA treatment. This study included
486 patients out of 2229 HBV infected patients visited
Hiroshima University hospital between January 1986 and
December 2017. The primary end point was the development
of HCC. The cumulative incidence and risk factors of HCC
were evaluated by the Kaplan-Meier method and multivariate
Cox proportional hazards models. The study was approved
by the institutional ethical review board. Results: Seventy
three out of 486 patients have developed HCC during the
follow-up period. The Kaplan-Meier method identified age
(51 ≤, P < 0.0001), male (P = 0.0106), Platelet count (≤ 15.9
× 104 /μL, P = 0.0002), HBcrAg level (3.7 log U/mL ≤, P <
0.0001), Aspartate aminotransferase level (38.5 U/L ≤, P =
0.0443), Total bilirubin (T-Bil) level (0.8 mg/dL ≤, P = 0.0025)
and Albumin level (≤ 4.1 g/dL, P = 0.0003) as significant risk
factor for HCC. Multivariate analysis identified HBcrAg level
(hazard ratio [HR], 15.380; P < 0.001), platelet count (HR,
2.652; P = 0.015) and T-Bil level (HR, 2.668; P < 0.0029) as
significant risk factor for HCC. Conclusion: Higher HBcrAg
level, higher total bilirubin level and lower platelet count
were associated with an increased risk of developing HCC in
patients undergoing NAs treatment. HBcrAg could be a novel
risk marker for predicting patients who develop HCC after
inducing NAs treatment.

StephenW

2116
乙型肝炎核心相关抗原（HΒcrΑg）
是一种新的肝细胞风险标记物
核苷类似物中的癌
治疗
Hatsue Fujino，胃肠病学系和
代谢，广岛大学和Kazuaki Chayama，
中国科学院消化内科新陈代谢研究所
广岛大学生物医学与健康科学
背景：感染乙型肝炎病毒（HBV）的患者
有发展肝硬化和肝细胞的高风险
癌（HCC）。虽然核苷（酸）类似物（NAs）
治疗使得控制慢性乙型肝炎成为可能
肝脏疾病，肝癌发生的风险仍然存在。
最近，乙型肝炎核心相关抗原（HBcrAg）已经发生
据报道，它是疾病监测和血清学的标志物
慢性乙型肝炎的预后。我们评估了风险
HBV感染患者HCC发生的因素
在NAs治疗期间，包括HBcrAg。方法：本研究
包括HBV感染患者诱导的NAs（拉米夫定，
阿德福韦，恩替卡韦，替诺福韦）没有HCC。下列
应用排除标准：1）与肝炎共感染
C，或人类免疫缺陷病毒，2）自身免疫
肝炎，或原发性胆汁性胆管炎，3）急性肝功能衰竭
在第一次访问时，4）在随访期间突破性肝炎
期间，5）预防HBV再激活，和6）病史
肝移植。 HBcrAg在测量之前测量或测量
NA治疗后引入。这项研究包括
访问了2229名HBV感染患者中的486名患者
1986年1月至1986年间广岛大学医院
2017年12月。主要终点是发展
HCC。 HCC的累积发病率和危险因素
通过Kaplan-Meier方法和多变量评估
Cox比例风险模型。该研究获得批准
由机构伦理审查委员会。结果：七十
486名患者中有3名患者在此期间发生了HCC
随访期。 Kaplan-Meier方法确定了年龄
（51≤，P <0.0001），男性（P = 0.0106），血小板计数（≤15.9
×104 /μL，P = 0.0002），HBcrAg水平（3.7 log U /mL≤，P <
0.0001），天冬氨酸氨基转移酶水平（38.5 U /L≤，P =
0.0443），总胆红素（T-Bil）水平（0.8 mg /dL≤，P = 0.0025）
白蛋白水平（≤4.1g / dL，P = 0.0003）为显着风险
HCC的因素。多变量分析确定HBcrAg水平
（风险比[HR]，15.380; P <0.001），血小板计数（HR，
2.652; P = 0.015）和T-Bil水平（HR，2.668; P <0.0029）为
HCC的重要危险因素。结论：HBcrAg较高
水平，总胆红素水平较高和血小板计数较低
与发生HCC的风险增加有关
接受NAs治疗的患者。 HBcrAg可能是一部小说
预测HCC患者发生HCC的风险标记
诱导NAs治疗。