亚洲人慢性乙型肝炎的抗病毒治疗和骨质减少/骨质疏松症的

StephenW

J Med Virol. 2019 Feb 18. doi: 10.1002/jmv.25433. [Epub ahead of print]
Antiviral therapy and the development of osteopenia/osteoporosis among Asians with chronic hepatitis B.
Wei MT1, Le AK1, Chang MS2, Hsu H3, Nguyen P1, Zhang JQ4, Wong C5, Wong C6, Cheung R7, Nguyen MH1.
Author information

1
    Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA.
2
    Department of Gastroenterology, Kaiser Permanente, Northern California, Santa Clara, CA.
3
    School of Medicine and Department of Medical Research, Fu-Jen Catholic University, New Taipei, Taiwan.
4
    Chinese Hospital, San Francisco, CA.
5
    C. Wong Clinic, San Francisco, CA.
6
    CL. Wong Clinic, San Francisco, CA.
7
    Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.

Abstract
BACKGROUND:

Recent studies have suggested a potential increase in the incidence of osteoporosis for patients receiving tenofovir disoproxil fumarate (TDF), but this issue remains controversial.
METHODS:

Retrospective cohort study of 1,224 Asian chronic hepatitis B (CHB) patients >18 years without baseline osteopenia/osteoporosis seen at four U.S. centers from 2008-2016. Patients were categorized into three groups-treatment naive patients who initiated therapy with TDF (1) or entecavir (ETV) (2), or untreated patients (3). Patients were followed until development of osteopenia/osteoporosis or end of study.
RESULTS:

Of the 1,224 study patients, 276 were treated with TDF, 335 with ETV, and 613 were untreated. The prevalence of cirrhosis was lower for untreated patients (2.6% vs. 16.3% for TDF and 17.6% for ETV, p<0.001). The 8-year cumulative incidence rate of osteopenia/osteoporosis was 13.17% for TDF, 15.09% for ETV and 10.17% for untreated patients, with no statistically significant difference among the three groups (p=0.218). On multivariate Cox regression controlling for demographics, osteoporosis risk factors, albumin, and hepatitis B virus (HBV) DNA levels, neither TDF (adjusted HR 0.74, 95% CI: 0.34, 1.59) nor ETV (adjusted HR 0.98, 95% CI: 0.51, 1.90) were associated with increased osteopenia/osteoporosis risk compared to untreated patients.
CONCLUSIONS:

Our retrospective study suggests there is no significant increase in incidence of osteopenia/osteoporosis for CHB patients treated with TDF or ETV during median follow-up of about 4-5 years. However, further study with longer follow-up is needed as anti-HBV therapy is often lifelong or long-term and the development of osteopenia/osteoporosis can be a slow process. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.
KEYWORDS:

entecavir; hepatitis B; osteoporosis; tenofovir; viral hepatitis

PMID:
    30776311
DOI:
    10.1002/jmv.25433

StephenW

J Med Virol。 2019年2月18日doi：10.1002 / jmv.25433。 [印刷前的电子版]
亚洲人慢性乙型肝炎的抗病毒治疗和骨质减少/骨质疏松症的发展
Wei MT1，Le AK1，Chang MS2，Hsu H3，Nguyen P1，Zhang JQ4，Wong C5，Wong C6，Cheung R7，Nguyen MH1。
作者信息

1
    斯坦福大学消化内科和肝脏病学系，帕洛阿尔托，加利福尼亚州。
2
    加利福尼亚州北部加利福尼亚州圣克拉拉市Kaiser Permanente消化内科。
3
    台湾新北市辅仁天主教大学医学院和医学研究系。
4
    中国医院，旧金山，加利福尼亚州。
五
    C. Wong Clinic，旧金山，加利福尼亚州。
6
    CL。 Wong Clinic，旧金山，加利福尼亚州。
7
    美国加利福尼亚州帕洛阿尔托Palo Alto医疗保健系统退伍军人事务所消化内科和肝病学部。

抽象
背景：

最近的研究表明接受替诺福韦地索普西富马酸盐（TDF）的患者骨质疏松症的发病率可能会增加，但这个问题仍然存在争议。
方法：

回顾性队列研究了2008年至2016年在美国四个中心发现的1,224名无基线骨质减少/骨质疏松症的亚洲慢性乙型肝炎（CHB）患者。患者分为三组 - 开始接受TDF治疗的初治患者（1）或恩替卡韦（ETV）（2）或未治疗患者（3）。随访患者直至发生骨质减少/骨质疏松症或研究结束。
结果：

在1,224名研究患者中，276名接受TDF治疗，335名接受ETV治疗，613名未接受治疗。未治疗患者的肝硬化患病率较低（TDF为2.6％，TDF为17.3％，ETV为17.6％，p <0.001）。骨质疏松/骨质疏松症的8年累积发生率TDF为13.17％，ETV为15.09％，未治疗患者为10​​.17％，三组间差异无统计学意义（p = 0.218）。关于人口统计学，骨质疏松症危险因素，白蛋白和乙型肝炎病毒（HBV）DNA水平的多变量Cox回归控制，TDF（调整后的HR 0.74,95％CI：0.34,1.59）和ETV（调整后的HR 0.98,95％CI：与未治疗的患者相比，0.51,1.90）与骨质减少/骨质疏松症风险增加相关。
结论：

我们的回顾性研究表明，在中位随访约4  -  5年期间，接受TDF或ETV治疗的CHB患者骨质减少/骨质疏松症的发生率没有显着增加。然而，需要进行更长时间随访的进一步研究，因为抗HBV治疗通常是终身或长期的，并且骨质减少/骨质疏松症的发展可能是一个缓慢的过程。本文受版权保护。版权所有。

本文受版权保护。版权所有。
关键词：

恩替卡韦;乙型肝炎;骨质疏松症;替诺福韦;病毒性肝炎

结论：
    30776311
DOI：
    10.1002 / jmv.25433