慢性HBV感染中度病毒负荷患者的高水平乙肝核心相关抗原与

StephenW

High Level of Hepatitis B Core–Related Antigen Associated With Increased Risk of Hepatocellular Carcinoma in Patients With Chronic HBV Infection of Intermediate Viral Load
Tai-Chung Tseng1,2
, Chun-Jen Liu1,2,3
, Chen-Yang Hsu4
, Chun-Ming Hong1,5
, Tung-Hung Su1,2
, Wan-Ting Yang2
, Chi-Ling Chen3
, Hung-Chih Yang1,3,6
, Yen-Tsung Huang7
, Stephanie Fang-Tzu Kuo8
, Chen-Hua Liu1,2
, Pei-Jer Chen1,2,3
, Ding-Shinn Chen9
, Jia-Horng Kao1,2,3,10,∗,'Correspondence information about the author Jia-Horng KaoEmail the author Jia-Horng Kao
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Background & Aims

Chronic hepatitis B virus (HBV) infection is a risk factor for hepatocellular carcinoma (HCC). Serum levels of HB core–related antigen (HBcrAg) have been associated with active replication of HBV. We investigated whether HBcrAg levels are associated with development of HCC, especially in patients who do not require antiviral treatment.
Methods

We collected data from 2666 adults positive for hepatitis B surface antigen (HBsAg), infected with HBV genotypes B or C, and without liver cirrhosis, who had long-term follow-up at the National Taiwan University Hospital from 1985 through 2000. None of the patients received antiviral treatment during the follow-up. Baseline levels of HBV DNA, HBsAg, and HBcrAg were determined retrospectively and participants were followed for a mean of 15.95 years. The primary end point was an association between serum level of HBcrAg and HCC development.
Results

HCC developed in 209 patients in the cohort (incidence rate, 4.91 cases/1000 person-years). We found a positive association between baseline level of HBcrAg and HCC development; HBcrAg level was an independent risk factor in multivariable analysis. In the subgroup of hepatitis B e antigen–negative patients with HBV DNA levels from 2000 to 19,999 IU/mL (intermediate viral load [IVL]) and normal levels of alanine aminotransferase, HBcrAg levels of 10 KU/mL or more identified patients at increased risk of HCC (hazard ratio, 6.29; confidence interval, 2.27–17.48). Patients with an IVL and a high level of HBcrAg had a risk for HCC that did not differ significantly from that of patients with a high viral load (≥20,000 IU/mL). Patients with an IVL but a low level of HBcrAg had a low risk of HCC, with an annual incidence rate of 0.10% (95% confidence interval, 0.04%–0.24%).
Conclusions

In a long-term follow-up study of 2666 patients with chronic HBV infection (genotypes B or C), level of HBcrAg is an independent risk factor of HCC. Moreover, HBcrAg level of 10 KU/mL identifies patients with an IVL who are at high risk for HCC.

StephenW

慢性HBV感染中度病毒负荷患者的高水平乙肝核心相关抗原与肝细胞癌风险增加相关
曾大中1,2
，刘纯仁1,2,3
，许晨阳4
洪春明1,5
，苏东雄1,2
杨婉婷2
陈志玲3
，杨洪志1,3,6
黄仁宗7
，斯蒂芬妮·方慈国8
，刘晨华1,2
，陈佩杰1,2,3
陈鼎信9
，Kao-Horng Kao1,2,3,10，∗，'关于作者Jia-Horng Kao的通讯信息给作者Jia-Horng Kao发电子邮件
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背景与目标

慢性乙型肝炎病毒（HBV）感染是肝细胞癌（HCC）的危险因素。血清HB核心相关抗原（HBcrAg）的水平与HBV的主动复制有关。我们调查了HBcrAg水平是否与HCC的发生有关，特别是在不需要抗病毒治疗的患者中。
方法

我们收集了2666名乙型肝炎表面抗原（HBsAg）阳性，感染了HBV基因型B或C且无肝硬化的成年人的数据，他们从1985年至2000年在国立台湾大学医院进行了长期随访。患者在随访期间接受了抗病毒治疗。回顾性确定基线水平的HBV DNA，HBsAg和HBcrAg，参与者平均随访15.95年。主要终点是血清HBcrAg与肝癌发生的关系。
结果

该队列中有209例患者发生了HCC（发生率，4.91例/ 1000人年）。我们发现基线水平的HBcrAg与肝癌的发生呈正相关。 HBcrAg水平是多变量分析中的独立危险因素。在乙型肝炎e抗原亚组中，HBV DNA含量为2000至19,999 IU / mL（中度病毒载量[IVL]）且丙氨酸转氨酶水平正常的阴性患者，HBcrAg水平为10 KU / mL或以上的患者被确定为肝癌的风险增加（危险比6.29；置信区间2.27-17.48）。具有IVL和高水平HBcrAg的患者发生HCC的风险与高病毒载量（≥20,000IU / mL）的患者无明显差异。 IVL但HBcrAg水平低的患者发生HCC的风险较低，年发生率为0.10％（95％置信区间，0.04％-0.24％）。
结论

在一项对2666例慢性HBV感染（B型或C型）患者的长期随访研究中，HBcrAg水平是HCC的独立危险因素。此外，HBcrAg水平为10 KU / mL可以识别出具有高肝癌风险的IVL患者。

StephenW

https://www.gastrojournal.org/ar ... aven_jbs_etoc_email