与抗病毒药物的病毒学应答相比，未经治疗的极少数活动性

StephenW

Clin Transl Gastroenterol. 2019 May 17. doi: 10.14309/ctg.0000000000000036. [Epub ahead of print]
Prognosis of Untreated Minimally Active Chronic Hepatitis B Patients in Comparison With Virological Responders by Antivirals.
Lee HW1,2, Kim SU3, Park JY3, Baatarkhuu O1,4, Kim DY3, Ahn SH3, Han KH3, Kim BK3.
Author information

1
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
2
    Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
3
    Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
4
    Department of Infectious Diseases, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.

Abstract
OBJECTIVES:

Serum hepatitis B virus (HBV)-DNA > 2,000 IU/mL is associated with higher risk of disease progression. However, without hepatocellular carcinoma (HCC) or cirrhosis, nucleos(t)ide analogs (NUCs) are recommended only for patients with elevated serum HBV-DNA and alanine aminotransferase ≥2 × upper normal limit.
METHODS:

We evaluated prognosis of untreated minimally active (MA) hepatitis patients (defined as HBV-DNA > 2,000 IU/mL, but never fulfilling current criteria for NUCs during follow-up) (untreated MA group), compared to virological responders by NUCs (NUC-VR group). Eligible patients undergoing transient elastography were consecutively enrolled. Patients with an immune-tolerant or inactive phase and with cirrhosis or HCC at enrollment were excluded. Cumulative risks of disease progression were assessed using the Kaplan-Meier method.
RESULTS:

The untreated MA group (n = 152) had higher HBV-DNA, alanine aminotransferase, and total bilirubin levels, and lower proportions of male and positive hepatitis B e antigen, compared to the NUC-VR group (n = 641). The untreated MA group had higher risks of HCC (adjusted hazard ratio [HR] 3.485, 95% confidence interval [CI] 1.234-9.846; P = 0.018), but similar risks of cirrhotic complications (adjusted HR 0.649, 95% CI 0.227-1.854; P = 0.420), compared to the NUC-VR group. Inverse probability of treatment weighting analysis using propensity score showed that the untreated MA group had higher risks of HCC (HR 4.464, 95% CI 2.008-9.901; P < 0.001), but similar risks of cirrhotic complications (HR 1.171, 95% CI 0.594-2.309; P = 0.649), compared to the NUC-VR group.
DISCUSSION:

Through appropriate adjustment of potential prognostic factors, the untreated MA group consistently showed higher risks of HCC, but similar risks of cirrhotic complications, compared to the NUC-VR group. HCC risk might be reduced through earlier NUCs for the untreated MA group.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PMID:
    31107725
DOI:
    10.14309/ctg.0000000000000036

StephenW

Clin Transl Gastroenterol。 2019年5月17日。土井：10.14309 / ctg.0000000000000036。 [印刷前的电子版]
与抗病毒药物的病毒学应答相比，未经治疗的极少数活动性慢性乙型肝炎患者的预后。
Lee HW1,2，Kim SU3，Park JY3，Baatarkhuu O1,4，Kim DY3，Ahn SH3，Han KH3，Kim BK3。
作者信息

1
    韩国延世大学医学院内科，韩国首尔。
2
    韩国首尔Severance医院延世肝脏中心。
3
    韩国首尔延世大学医学院消化内科研究所。
4
    蒙古国立医科大学传染病系，蒙古乌兰巴托。

抽象
目的：

血清乙型肝炎病毒（HBV）-DNA> 2,000 IU / mL与疾病进展的高风险相关。然而，没有肝细胞癌（HCC）或肝硬化，核苷（t）ide类似物（NUCs）仅推荐用于血清HBV-DNA升高和丙氨酸氨基转移酶≥2×正常上限的患者。
方法：

我们评估了未治疗的微小活动（MA）肝炎患者的预后（定义为HBV-DNA> 2,000 IU / mL，但在随访期间从未满足NUC的当前标准）（未治​​疗的MA组），与NUC的病毒学应答者（NUC）相比较-VR组）。接受短暂弹性成像的符合条件的患者被连续登记。入组时具有免疫耐受或无活动期和肝硬化或HCC的患者被排除在外。使用Kaplan-Meier方法评估疾病进展的累积风险。
结果：

与NUC-VR组相比，未治疗的MA组（n = 152）具有更高的HBV-DNA，丙氨酸氨基转移酶和总胆红素水平，以及更低比例的雄性和阳性乙型肝炎e抗原（n = 641）。未治疗的MA组患HCC的风险较高（校正风险比[HR] 3.485,95％置信区间[CI] 1.234-9.846; P = 0.018），但肝硬化并发症的风险相似（调整后HR 0.649,95％CI 0.227-与NUC-VR组相比，1.854; P = 0.420）。使用倾向评分的治疗加权分析的反向概率显示未治疗的MA组具有较高的HCC风险（HR 4.464,95％CI 2.008-9.901; P <0.001），但肝硬化并发症的风险相似（HR 1.171,95％CI 0.594）与NUC-VR组相比，-2.309; P = 0.649）。
讨论：

通过适当调整潜在的预后因素，与NUC-VR组相比，未治疗的MA组始终表现出更高的HCC风险，但肝硬化并发症风险相似。通过早期NUC对未经治疗的MA组可能会降低HCC风险。这是根据知识共享署名 - 非商业 - 无衍生物许可证4.0（CCBY-NC-ND）的条款分发的开放获取文章，允许下载和分享工作，只要它被正确引用。未经期刊许可，不得以任何方式更改作品或在商业上使用。

结论：
    31107725
DOI：
    10.14309 / ctg.0000000000000036