用有效抗病毒药物治疗HBV相关性肝硬化患者的肝癌完全病毒

StephenW

Kaohsiung J Med Sci. 2019 Aug 20. doi: 10.1002/kjm2.12114. [Epub ahead of print]
Liver stiffness measurement at complete virological response in hepatoma prediction for HBV-related cirrhosis patient with potent antiviral agent.
Wang JH1, Hu TH1, Chen CH1, Hung CH1, Yen YH1, Chang KC1, Lu SN2.
Author information

1
    Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan.
2
    Division of Hepato-Gastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.

Abstract

Hepatocellular carcinoma (HCC) development is ameliorated with nucleos(t)ide agent (NA) therapy for hepatitis B virus (HBV)-related cirrhosis patients. This study investigates whether liver stiffness (LS) measurement at complete virological response (CVR) was useful in predicting HCC development. Between July 2006 and August 2016, HBV-related cirrhosis patients with potent NA (entecavir/tenofovir) with the first LS measurement during CVR and with serial LS were enrolled. Patients developing HCC 6 months after potent NA or before the first LS measurement were excluded. Three hundred and seventy-one patients were enrolled. The median follow-up was 5.6 and 3.8 years from potent NA treatment and the first LS measurement respectively. Twenty-seven patients developed HCC. The 1-, 3-, 5- and 7-year cumulated incidences of HCC occurrence were 0%, 2.8%, 5.8% and 9%, respectively. In addition to age > 57 years, LS > =21.5 kPa (HR: 3.86, 95%CI: 1.67-8.94) was an independent factor associated with HCC occurrence in multivariate analysis. However, the magnitude of change in LS was not associated with HCC development. For the first LS in HCC prediction, the performance was 0.636. There were two to thirteen LS measurements during CVR. The change in LS was classified into four patterns stratified by the first and serial LS. Compared with those with serial LS < 21.5 kPa, patients with LS > =21.5 kPa tend to have higher HCC occurrence (P = .062). In summary, LS at CVR was an independent factor associated with HCC development for HBV-related cirrhosis patients with potent NA. However, LS was not satisfactory in the prediction performance of HCC development.

© 2019 The Authors. The Kaohsiung Journal of Medical Sciences published by John Wiley & Sons Australia on behalf of Kaohsiung Medical University.
KEYWORDS:

hepatic cirrhosis; hepatitis B virus; hepatocellular carcinoma; liver stiffness; nucleos(t)ide agent

PMID:
    31430035
DOI:
    10.1002/kjm2.12114

StephenW

Kaohsiung J Med Sci。 2019年8月20日doi：10.1002 / kjm2.12114。 [印刷前的电子版]
用有效抗病毒药物治疗HBV相关性肝硬化患者的肝癌完全病毒学应答的肝硬度测量。
Wang JH1，Hu TH1，Chen CH1，Hung CH1，Yen YH1，Chang KC1，Lu SN2。
作者信息

1
    台湾高雄市高雄长庚纪念医院和长庚大学医学院内科，肝内科，肝内科
2
    台湾嘉义嘉义长庚纪念医院内科，肝内科

抽象

用乙型肝炎病毒（HBV）相关的肝硬化患者的核（t）ide试剂（NA）治疗改善肝细胞癌（HCC）的发展。本研究调查完全病毒学应答（CVR）的肝硬度（LS）测量是否有助于预测HCC的发展。 2006年7月至2016年8月期间，HBV相关的肝硬化患者接受了强效NA（恩替卡韦/替诺福韦），在CVR和连续LS期间进行了第一次LS测量。在强效NA后6个月或在第一次LS测量之前发生HCC的患者被排除在外。招募了371名患者。中位随访分别为强效NA治疗和第一次LS测量的5.6和3。8年。 27名患者发展为HCC。 HCC发生的1年，3年，5年和7年累积发生率分别为0％，2.8％，5.8％和9％。除年龄> 57岁外，LS> = 21.5 kPa（HR：3.86,95％CI：1.67-8.94）是多变量分析中与HCC发生相关的独立因素。然而，LS的变化幅度与HCC的发展无关。对于HCC预测中的第一个LS，性能为0.636。在CVR期间有两到十三个LS测量。 LS的变化分为由第一和连续LS分层的四种模式。与序列LS <21.5 kPa的患者相比，LS> = 21.5 kPa的患者HCC发生率更高（P = .062）。总之，CVR的LS是与具有强效NA的HBV相关肝硬化患者的HCC发展相关的独立因素。然而，LS在HCC发展的预测性能方面并不令人满意。

©2019作者。高雄医学科学杂志由John Wiley＆Sons Australia代表高雄医科大学出版。
关键词：

肝硬化;乙型肝炎病毒;肝细胞癌;肝硬度;核苷（t）ide剂

结论：
    31430035
DOI：
    10.1002 / kjm2.12114

StephenW

https://onlinelibrary.wiley.com/doi/pdf/10.1002/kjm2.12114