EASL2019 THU-231 免疫耐受的患者患肝细胞癌的风险 慢性乙型肝

StephenW

THU-231
Risk of hepatocellular carcinoma in patients with immunetolerant
chronic hepatitis B
Gyeol Seong1, Dong Hyun Sinn1, Wonseok Kang1, Geum-Yon Gwak1,
Moon Seok Choi1, Kwang Cheol Koh1, Seoung Woon Paik1,
Yong Han Paik1. 1Samsung Medical Center, Seoul, Korea, Rep. of South
Email: [email protected]
Background and aims: Recent studies have suggested that patients
with immune-tolerant chronic hepatitis B (CHB), characterized by
hepatitis b e antigen (HBeAg) positive patients with high serum
hepatitis B virus (HBV) DNA but normal alanine aminotransferase(ALT), may develop hepatocellular carcinoma (HCC). However, it is
unclear how to stratify HCC risk in these patients.
Method: A retrospective cohort of 651 HBeAg positive, adult patients
with high serum HBV DNA levels (>7 log IU/ml) but normal or mildly
elevated ALT levels (<80 U/L) were analyzed. Age and FIB-4 index
were used to categorize patients, and assessed HCC incidence rate in
each subgroups. Normal ALTwas defined as <35 U/L for males and <25
U/L for females.
Results: During a median 5.2 years of follow-up (range: 1.0-17.8
years), 24 (3.7%) patients developed HCC. Age and FIB-4 index were
independent factors associated with HCC development. When
stratified, 5 and 10-year cumulative HCC incidence rates were 0%
and 2.0% for patients aged <40 years plus FIB-4 index <1.45, andwere
5.9% and 32.7% for patients aged ≥ 40 years plus FIB-4 index ≥ 1.45,
respectively (p < 0.001). In patients with normal ALT levels (n = 301),
10-year HCC incidence rate was 0% for patients aged <40 years plus
FIB-4 index <1.45, while 5 and 10-years HCC incidence rate was 4.5%
and 27.1% for patients aged ≥ 40 years plus FIB-4 index ≥ 1.45,
respectively (p < 0.001).
Conclusion: In patients with immune-tolerant CHB, HCC risk was
considerably high for aged patients with elevated FIB-4 index while
HCC riskwas very lowfor young patients with lowFIB-4 index. These
two factors could effectively stratify HCC risk, indicating that they
may guide management plan for this population.

StephenW

THU-231
免疫耐受的患者患肝细胞癌的风险
慢性乙型肝炎
Gyeol Seong1，Dong Hyun Sinn1，Wonseok Kang1，Geum-Yon Gwak1，
Moon Seok Choi1，Kwang Cheol Koh1，Seoung Woon Paik1，
Yong Han Paik1。 1Samsung医疗中心，韩国首尔，南方代表
电子邮件：[email protected]
背景和目的：最近的研究表明患者
以免疫耐受的慢性乙型肝炎（CHB）为特征
乙型肝炎e抗原（HBeAg）阳性患者血清高
乙型肝炎病毒（HBV）DNA但正常丙氨酸氨基转移酶（ALT）可能发展为肝细胞癌（HCC）。但是，确实如此
目前尚不清楚如何对这些患者的HCC风险进行分层。
方法：回顾性队列研究651例HBeAg阳性，成人患者
具有高血清HBV DNA水平（> 7 log IU / ml）但正常或轻度
分析升高的ALT水平（<80U / L）。年龄和FIB-4指数
用于分类患者，并评估HCC的发病率
每个小组。正常ALT定义为男性<35 U / L且<25
U / L为女性。
结果：中位随访5。2年（范围：1.0-17.8
年，24名（3.7％）患者发生HCC。年龄和FIB-4指数分别为
与HCC发展相关的独立因素。什么时候
分层，5年和10年累积HCC发病率为0％
年龄<40岁且加FIB-4指数<1.45的患者为2.0％
年龄≥40岁且FIB-4指数≥1.45的患者为5.9％和32.7％，
分别（p <0.001）。在ALT水平正常的患者中（n = 301），
年龄<40岁的患者10年HCC发病率为0％
FIB-4指数<1.45，而5年和10年HCC发病率为4.5％
年龄≥40岁且FIB-4指数≥1.45的患者为27.1％，
分别（p <0.001）。
结论：在免疫耐受的CHB患者中，HCC风险为
FIB-4指数升高的老年患者相当高
对于具有低FIB-4指数的年轻患者，HCC风险非常低。这些
两个因素可以有效地分层HCC风险，表明它们
可以指导这个人口的管理计划。

newchinabok

年老了，患hcc的概率变大了。hbvdna高滴度也是一个因素