[抗病毒和抗纤维化治疗可减少慢性乙型肝炎和肝纤维化患者

StephenW

Nan Fang Yi Ke Da Xue Xue Bao. 2019 Jun 30;39(6):633-640. doi: 10.12122/j.issn.1673-4254.2019.06.02.
[Antiviral and antifibrotic therapies reduce occurrence of hepatocellular carcinoma in patients with chronic hepatitis B and liver fibrosis: a 144-week prospective cohort study].
[Article in Chinese]
Zhou Y1,2, Hu C3, Yuan G3, Liu J3, Ren Y3, Tang C3, Yang S3, Dai L3, Li Y3, Yang D1.
Author information

1
    Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
2
    Department of Surgery, Hospital of Integrated TCM and Western Medicine, Southern Medical University, Guangzhou 510315, China.
3
    Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Abstract
OBJECTIVE:

To compare the efficacy and safety of different antiviral and antifibrotic regimens in patients with chronic hepatitis B (CHB) and hepatic fibrosis and the incidence of hepatocellular carcinoma (HCC) associated with these therapies.
METHODS:

A total of 840 patients with CHB and concurrent hepatic fibrosis, who received antiviral therapy in Nanfang Hospital between June, 2010 and June, 2018, were enrolled in this follow-up cohort study. The patients were assigned to 3 cohorts matched for gender, age (difference≤5 years), HBeAg status and liver stiffness measurement (LSM) for treatment with one of the 3 antiviral drugs, namely entecavir, tenofovir dipivoxil and adefovir dipivoxil; each cohort was divided into 2 groups, with one of the groups having a combined treatment with Fufang Biejiaruangan tablet. The cumulative negative conversion rate of HBV DNA, normalization rate of ALT, hepatic fibrosis regression and the incidence of HCC were compared among the 3 cohorts and across the 6 groups at 144 weeks.
RESULTS:

A total of 749 patients were available to follow-up at 144 weeks. Compared with the baseline data, the cumulative negative conversion rate of HBV DNA increased gradually and the abnormal rate of ALT decreased significantly over time during the treatment in all the 6 groups (all P < 0.001). Compared with the any of the antiviral drugs used alone, the combined treatments all resulted in significantly better antifibrotic effects (χETV cohort2=11.345, χTDF cohort2=10.160, χADV cohort2=6.358; all P < 0.05). At 144 weeks, the incidence of HCC were 2.2%, 1.7%, 1.7% and 3.3% in enecavir group, enecavir with Biejiaruangan tablet group, adefovir group, and adefovir with Biejiaruangan tablet group, respectively, showing no significant difference between the two cohorts (4 groups; χ2=6.813, P=0.138). None of the patients in the 2 groups with tenofovir treatment had HCC by the end of the observation.
CONCLUSIONS:

Antiviral therapy combined with antifibrotic therapy can effectively reverse hepatic fibrosis and reduce the incidence of HCC in patients with CHB; among the 3 antiviral drugs, tenofovir dipivoxil can be a better option for reducing the incidence of HCC in these patients.
KEYWORDS:

anti-fibrosis; anti-viral; chronic; hepatitis B; hepatocellular carcinoma; liver fibrosis

PMID:
    31270040
DOI:
    10.12122/j.issn.1673-4254.2019.06.02

StephenW

南方一科大学学报。 2019年6月30日; 39（6）：633-640。 doi：10.12122 / j.issn.1673-4254.2019.06.02。
[抗病毒和抗纤维化治疗可减少慢性乙型肝炎和肝纤维化患者肝细胞癌的发生：144周的前瞻性队列研究]。
[中文]
周Y 1,2，胡C3，袁G3，刘J3，任Y3，唐C3，杨S3，戴L3，李Y3，杨D1。
作者信息

1
南方医科大学南方医院肝胆外科，广东广州510515
2
南方医科大学中西医结合医院外科，广东广州510315
3
南方医科大学南方医院感染科，广东广州510515

抽象
目的：

比较不同抗病毒和抗纤维化方案在慢性乙型肝炎（CHB）和肝纤维化患者中的疗效和安全性以及与这些疗法相关的肝细胞癌（HCC）的发生率。
方法：

2010年6月至2018年6月，在南方医院接受抗病毒治疗的共有840名CHB和并发肝纤维化患者参加了该随访队列研究。患者被分配到3个性别，年龄（差异≤5岁），HBeAg状态和肝硬度测量（LSM）的队列中，用3种抗病毒药物之一，即恩替卡韦，替诺福韦酯和阿德福韦酯治疗;每组均分为2组，其中一组与复方鳖甲软肝片联合发酵。比较3个队列和6个组在144周时HBV DNA的累积阴性转换率，ALT正常化率，肝纤维化消退和HCC发生率。
结果：

共有749名患者可在144周时进行随访。与基线数据相比，所有6组HBV DNA的累积负转化率逐渐增加，ALT异常率随着时间的推移显着下降（均P <0.001）。与单独使用的任何抗病毒药物相比，联合治疗均导致显着更好的抗纤维化作用（χETV组群2 = 11.345，χTDF组群2 = 10.160，χADV组群2 = 6.358;所有P <0.05）在144周时，恩卡韦尔组，恩加韦尔组，阿德福韦组，阿德福韦酯，鳖甲软肝片组分别为2.2％，1.7％，1.7％和3.3％，两组间差异无统计学意义（4组;χ2= 6.813） ，P = 0.138）。在观察结束时，接受替诺福韦治疗的两组患者均未患有HCC。
结论：

抗病毒治疗联合抗纤维化治疗可有效逆转肝纤维化，降低CHB患者的HCC发病率;在3种抗病毒药物中，替诺福韦酯可以是降低这些患者HCC发病率的更好选择。
关键词：

抗纤维化;抗病毒;慢性;乙型肝炎;肝细胞癌;肝纤维化

结论：
31270040
DOI：
10.12122 / j.issn.1673-4254.2019.06.02