免疫性非活动性慢性乙型肝炎肝细胞癌风险的预测因素。

StephenW

Clin Res Hepatol Gastroenterol. 2020 Jan 17. pii: S2210-7401(19)30275-X. doi: 10.1016/j.clinre.2019.10.009. [Epub ahead of print]
Predictive factors for risk of hepatocellular carcinoma in immune inactive chronic hepatitis B.
Seo SI1, Kim HS2, Yang BK1, Kang JG1, Shin WG1, Lee JH1, Kim HY1, Jang MK1.
Author information

1
    Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Sungnae-gil, Kangdong-gu, Seoul, Republic of Korea 134-701.
2
    Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Sungnae-gil, Kangdong-gu, Seoul, Republic of Korea 134-701. Electronic address: [email protected].

Abstract
BACKGROUND AND AIMS:

The risk factors for hepatocellular carcinoma (HCC) in immune inactive chronic hepatitis B (CHB) have not been clarified. The aim of this study was to investigate the predictive factors for HCC inimmune inactive CHB.
METHODS:

A total of 337 patients in immune inactive CHB were consecutively enrolled in Kangdong Sacred Heart Hospital from 1995 to 2017. Univariate and multivariate analyses were performed to identify the independent risk factors for HCC development.
RESULTS:

During the mean 63 months of follow-up, the incidence of HCC of study population was 4.5% (15/337). Patients who developed HCC were older, had more cirrhosis at baseline, and were more likely to experience ALT elevation>2 X upper limit of normal (ULN) during follow-up than those without HCC. In Cox regression analysis, increased ALT levels>2 X ULN during follow-up (hazard ratio [HR], 3.774; 95% confidence interval [CI], 1.145-12.443; P=0.029] and presence of cirrhosis (HR, 11.768; 95% CI, 3.350-41.336; P<0.001) were identified as the independent factors for HCC in immune inactive CHB. With increasing number of risk factors, the respective cumulative incidence of HCC at 10 years was 6.3%, 8.8%, and 63.5%.
CONCLUSIONS:

Underlying cirrhosis and hepatic inflammation reflected by increased ALT levels>2 X ULN were significant predictors for HCC in immune inactive CHB. ALT elevation showed a synergistic effect in HCC development combined with cirrhosis. It suggests that patients with high serum ALT levels, especially those with cirrhosis, are required closer surveillance for HCC even in immune inactive CHB.

Copyright © 2020 Elsevier Masson SAS. All rights reserved.
KEYWORDS:

Chronic hepatitis B; Hepatocellular carcinoma; Immune inactive phase

PMID:
    31959567
DOI:
    10.1016/j.clinre.2019.10.009

StephenW

Clin Res Hepatol胃肠酸。 2020年1月17日。pii：S2210-7401（19）30275-X。 Doi：10.1016 / j.clinre.2019.10.009。 [Epub提前发行]
免疫性非活动性慢性乙型肝炎肝细胞癌风险的预测因素。
Seo SI1，Kim HS2，Yang BK1，Kang JG1，Shin WG1，Lee JH1，Kim HY1，Jang MK1。
作者信息

1个
134-701，韩国首尔市江东区崇礼街150号，哈林大学医学院康东圣心医院内科。
2
134-701，韩国首尔市江东区崇礼街150号，哈林大学医学院康东圣心医院内科。电子地址：[email protected]。

抽象
背景与目的：

尚未阐明免疫性非活动性慢性乙型肝炎（CHB）中肝细胞癌（HCC）的危险因素。这项研究的目的是调查HCC免疫惰性CHB的预测因素。
方法：

从1995年至2017年，共有337例免疫无效的CHB患者在康东圣心医院连续入组。进行了单因素和多因素分析，以确定肝癌发生的独立危险因素。
结果：

在平均63个月的随访期间，研究人群的HCC发生率为4.5％（15/337）。与没有HCC的患者相比，发展为HCC的患者年龄更大，在基线时有更多的肝硬化，并且在随访期间ALT升高>正常值上限（ULN）的2倍。在Cox回归分析中，随访期间ALT升高> 2 X ULN（危险比[HR]为3.774； 95％置信区间[CI]为1.145 -12.443； P = 0.029）和肝硬化的存在（HR为11.768； 95％CI，3.350-41.336; P <0.001）被确定为免疫失活性CHB中HCC的独立因素。随着危险因素数量的增加，在10年时HCC的累积发生率分别为6.3％，8.8％和63.5。 ％。
结论：

ALT升高> 2 X ULN所反映的基础性肝硬化和肝炎是免疫失活性CHB中HCC的重要预测因子。 ALT升高在肝癌合并肝硬化的发展中具有协同作用。这表明，即使在免疫失活的CHB中，血清ALT水平高的患者，尤其是肝硬化患者，也需要更密切地监测HCC。

版权所有©2020 Elsevier Masson SAS。版权所有。
关键字：

慢性乙型肝炎；肝细胞癌；免疫非活动期

PMID：
31959567
DOI：
10.1016 / j.clinre.2019.10.009