用核苷（酸）类似物治疗的慢性乙型肝炎患者中高百分比的

StephenW

Medicine (Baltimore). 2019 Jan;98(1):e13818. doi: 10.1097/MD.0000000000013818.
High percentage atypical hepatocellular carcinoma in chronic hepatitis B patients treated with nucleos(t)ide analogs.
Lin CC1,2, Bair MJ1,3, Liu CY1,2, Lin ZY1, Chen CJ1,2, Chen MJ1,2, Chu CH1,2, Wang HY1,2, Shih SC1,2, Wang TE1,2.
Author information

1
    Mackay Medical College, New Taipei City.
2
    Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei.
3
    Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung, Taiwan.

Abstract

Nucleos(t)ide analogs are used for preventing liver cirrhosis in chronic hepatitis B patients, but the risk factors of hepatocellular carcinoma (HCC) in these patients remain unclear. We designed this retrospective cohort study, the aim is to determine the risk factors for HCC development and its image presentation under nucleos(t)ide analogs treatment.In this study, patients were treated with lamivudine (LAM), entecavir 0.5 mg (ETV), or telbivudine (LdT), and followed-up for at least 2 years to detect HCC and its presentation. Assessment of the risk factors for HCC included age, sex, HBeAg, viral load, liver cirrhosis, current and previous medications, and liver function tests.Totally, 396 patients were recruited, and 18 patients developed HCC. The mean time from the treatment to HCC development was 28.5 ± 16.7 months. The clinical characteristics in HCC and no-HCC groups showed significant differences among age (52.8 ± 6.1 vs 47.1 ± 12.6 years, P <.01), baseline alanine transaminase (ALT) levels (161.4 ± 177.3 vs 361.7 ± 496.3, P <.01), and baseline liver cirrhosis (72.2% vs 29.9%, P <.01). In patients aged ≥45 years, the hazard ratio of HCC was 10.2 and liver cirrhosis was 4.1. Majority of HCCs developed in the right liver (14/18), were single numbered (13/18), had tumor size about 1.9 ± 0.7 cm, were classified as T1 (14/18, TNM staging), and the atypical image occupied 88% of the HCC cases.The patients aged ≧45 years on long-term nucleos(t)ide analog therapy, and with baseline liver cirrhosis were at a high risk of HCC. Regular alpha-fetoprotein (AFP) assessment and image study of these patients are the gold standards for early HCC detection in patients with high percentage atypical HCC appearances.

PMID:
    30608393
DOI:
    10.1097/MD.0000000000013818

StephenW

医学（巴尔的摩）。 2019年1月; 98（1）：e13818。 doi：10.1097 / MD.0000000000013818。
用核苷（酸）类似物治疗的慢性乙型肝炎患者中高百分比的非典型肝细胞癌。
Lin CC1,2，Bair MJ1,3，Liu CY1,2，Lin ZY1，Chen CJ1,2，Chen MJ1,2，Chu CH1,2，Wang HY1,2，Shih SC1,2，Wang TE1,2。
作者信息

1
    新北市麦凯医学院。
2
    台北麦凯纪念医院内科，消化内科。
3
    台湾台东县台东分校麦凯纪念医院内科消化内科

抽象

Nucleos（t）ide类似物用于预防慢性乙型肝炎患者的肝硬化，但这些患者的肝细胞癌（HCC）的危险因素仍不清楚。我们设计了这项回顾性队列研究，目的是确定HCC发展的危险因素及其在核苷（酸）类似物治疗下的图像表现。本研究中，患者接受拉米夫定（LAM），恩替卡韦0.5 mg（ETV）治疗或替比夫定（LdT），并随访至少2年以检测HCC及其表现。评估HCC的危险因素包括年龄，性别，HBeAg，病毒载量，肝硬化，当前和既往药物以及肝功能检查。共招募396名患者，18名患者发生HCC。从治疗到HCC发展的平均时间为28.5±16.7个月。 HCC和无HCC组的临床特征在年龄（52.8±6.1 vs 47.1±12.6岁，P <.01），基线丙氨酸转氨酶（ALT）水平（161.4±177.3 vs 361.7±496.3，P <。 01）和基线肝硬化（72.2％vs 29.9％，P <.01）。在≥45岁的患者中，HCC的危险比为10.2，肝硬化为4.1。在右肝（14/18）发生的大多数HCC，单个编号（13/18），肿瘤大小约1.9±0.7 cm，被分类为T1（14/18，TNM分期），并且非典型图像被占用88％的HCC病例。长期核苷（酸）类似物治疗年龄≥45岁的患者和基线肝硬化患者的HCC风险较高。这些患者的定期甲胎蛋白（AFP）评估和图像研究是非典型HCC外观高百分比患者早期HCC检测的金标准。

结论：
    30608393
DOI：
    10.1097 / MD.0000000000013818