AASLD2019[197]乙肝慢性乙型肝炎的替诺福韦对肠溶 感染：对肝

StephenW

TENOFOVIR VERSUS ENTECAVIR IN HBV CHRONIC
INFECTION: IMPACT ON HCC AND OTHER LIVER-RELATED
COMPLICATIONS OCCURRENCES
Stanislas Pol, Hepatology Service, Assistance Publique —
Hôpitaux De Paris (AP—HP), Hôpital Cochin, and the ANRS/
AFEF HEPATHER Study Group
Background: HBV chronic hepatitis result in a high risk of
cirrhosis and its complications, hepatocellular carcinoma
(HCC), decompensation, liver transplantation or death
Nucleos(t)idic analogues (NUCs) have been clearly
associated with a reduction of complications, including HCC
Recent Asian cohort studies suggest that Tenofovir (TDF)
could be associated with a reduced risk of HCC or cirrhosis
complications as compared to Entecavir (ETV). The aim of our
study was to evaluate the impact of NUCs on the risk of HCC
in HBV-treated patients from the prospective ANRS CO22
Hepather cohort Methods: In the ANRS CO22 HEPATHER «
Therapeutic options for hepatitis B and C: a French cohort»,
6408 patients with past or present HBV-infection have been
included. We selected all 2768 HBeAg+/- (or undefined)
patients with chronic hepatitis B who were given NUCs at
entry in the cohort. HDV and HCV coinfected patients were
excluded. We compared incidences of HCC and other liver
complications or death (given for 1000 patients per year
(95%CI)) according to TDF or ETV treatment. Analyses were
adjusted on other predictors of clinical outcomes Results:
1515 patients received TDF, 1143 ETV (110 both treatment).
There was no difference between patients receiving TDF and
ETV as regards ethnicity, baseline cirrhosis, prior history of
liver-related events 75 HCC, 35 cirrhosis decompensation,
15 liver transplantation and 78 deaths were reported
during a over a median follow-up of 45 months (IQR 26-
53) The incidence of HCC, cirrhosis decompensation, liver
transplantation or death was not different between TDF- (8 8
(6 4;11 8), 3 4 (2 0;5 4), 2 6 (1 4;4 4) and 8 9 (6 5 ;12 0)) and
ETV-treated patients (9.1 (6.3;12.6), 4.9 (3.0;7.7), 1.3 (0.4;3.0)
and 11 1 (8 0 ;14 9))(Table) Univariable and multivariableadjusted
Hazard ratio showed no evidence of an association
between NUCs type and HCC, or other liver complications
Conclusion: In this first large prospective cohort of French
patients with HBV chronic hepatitis, including patients from
European, African as well as Asian origin, liver-related events
were not different between Tenofovir- and Entecavir-treated
patients.

StephenW

乙肝慢性乙型肝炎的替诺福韦对肠溶
感染：对肝癌和其他与肝有关的影响
复杂事件
Stanislas Pol，公共服务肝病服务-
巴黎Hôpitaux（AP-HP），HôpitalCochin和ANRS /
AFEF HEPATHER研究小组
背景：HBV慢性肝炎导致高风险
肝硬化及其并发症，肝细胞癌
（HCC），代偿失调，肝移植或死亡
核类似物（NUCs）已经很明显
减少包括肝癌在内的并发症
最近的亚洲队列研究表明，替诺福韦（TDF）
可能与降低HCC或肝硬化的风险有关
与恩替卡韦（ETV）相比并发症。我们的目标
研究是为了评估NUC对HCC风险的影响
前瞻性ANRS CO22治疗乙肝患者
Hepather群组方法：在ANRS CO22 HEPATHER«
乙型和丙型肝炎的治疗选择：法国人群»，
已经有6408名过去或现在的HBV感染患者
包括在内。我们选择了所有2768 HBeAg +/-（或未定义）
慢性乙型肝炎患者在
进入队列。 HDV和HCV合并感染的患者为
排除在外。我们比较了HCC和其他肝脏的发生率
并发症或死亡（每年1000名患者
（95％CI））根据TDF或ETV处理。分析是
根据其他临床结果预测因素进行调整结果：
1515例患者接受了TDF，1143例ETV（110例均接受治疗）。
接受TDF的患者与接受TDF的患者之间没有差异
关于种族，基线肝硬化，既往史的ETV
肝相关事件75肝癌，35肝硬化失代偿，
据报道有15例肝移植和78例死亡
在45个月的中位随访期间（IQR 26-
53）肝癌，肝硬化失代偿，肝病的发生率
TDF-（8 8
（6 4; 11 8），3 4（2 0; 5 4），2 6（1 4; 4 4）和8 9（6 5; 12 0））和
ETV治疗的患者（9.1（6.3; 12.6），4.9（3.0; 7.7），1.3（0.4; 3.0）
和11 1（8 0; 14 9））（表）单变量和多变量调整后
危险比表明没有关联的证据
在NUCs类型与HCC或其他肝脏并发症之间
结论：在法国的第一个大型预期队列中
HBV慢性肝炎患者，包括
欧洲，非洲以及亚洲血统的肝脏相关事件
替诺福韦和恩替卡韦治疗之间无差异
耐心。