慢性乙型肝炎患者抗病毒治疗后MELD评分改善的相关因素。

StephenW

J Gastroenterol Hepatol. 2020 Feb 7. doi: 10.1111/jgh.15007. [Epub ahead of print]
Factors associated with improvement in MELD score after antiviral treatment in patients with chronic hepatitis B.
Yip TC1,2,3, Lee HW1,2,3,4, Wong VW1,2,3, Wong GL1,2,3, Tse YK1,2, Lui GC1, Ahn SH4, Chan HL1,2,3.
Author information

1
    Institute of Digestive Disease.
2
    Department of Medicine and Therapeutics.
3
    State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
4
    Yonsei University College of Medicine, Seoul, South Korea.

Abstract
BACKGROUND & AIMS:

Improvement in Model for End-Stage Liver Disease (MELD) score during antiviral treatment is associated with reduced hepatic decompensation and death in patients with chronic hepatitis B (CHB)-related cirrhosis. We aimed to identify factors associated with transplant-free survival and on-treatment MELD score improvement.
METHODS:

We identified patients with CHB-related cirrhosis and MELD score ≥15 at the start of entecavir and/or tenofovir disoproxil fumarate treatment between 2005 and 2017. The primary endpoint was transplant-free survival at month 6. The secondary endpoints at month 6 were transplant-free survival with >5 point improvement in MELD score, and transplant-free survival with MELD score <15.
RESULTS:

Of 999 cirrhotic CHB patients, 605 (60.6%) achieved transplant-free survival at month 6. Proportion of transplant-free survival at month 6 stabilized at 10% in patients with high MELD. Patients who achieved transplant-free survival at month 6 were younger, had lower MELD score, lower alanine aminotransferase (ALT), and higher albumin at baseline. Of 605 patients with transplant-free survival, 276 (45.6%) achieved >5 point improvement in MELD score; 183 (30.2%) had 1-5 point improvement in MELD score; 146 (24.1%) had no improvement or a worsened MELD score. Also, 321 (53.1%) patients with transplant-free survival had a MELD score <15 at month 6.
CONCLUSION:

On top of lower MELD score, patients with CHB-related cirrhosis who are younger, have higher albumin, and lower ALT are more likely to achieve transplant-free survival after 6 months of antiviral treatment.

This article is protected by copyright. All rights reserved.
KEYWORDS:

MELD improvement; liver cirrhosis; transplant-free survival

PMID:
    32032974
DOI:
    10.1111/jgh.15007

StephenW

J胃肠肝素。 2020年2月7日。doi：10.1111 / jgh.15007。 [Epub提前发行]
慢性乙型肝炎患者抗病毒治疗后MELD评分改善的相关因素。
Yip TC1,2,3，Lee HW1,2,3,4，Wong VW1,2,3，Wong GL1,2,3，Tse YK1,2，Lui GC1，Ahn SH4，Chan HL1,2,3。
作者信息

1个
    消化疾病研究所。
2
    医学和治疗学系。
3
    香港中文大学，消化病国家重点实验室，香港特别行政区。
4
    延世大学医学院，韩国首尔。

抽象
背景与目的：

抗病毒治疗期间终末期肝病（MELD）评分模型的改善与慢性乙型肝炎（CHB）相关性肝硬化患者的肝失代偿和死亡减少有关。我们旨在确定与无移植生存和治疗中MELD评分改善相关的因素。
方法：

我们确定了2005年至2017年开始使用恩替卡韦和/或替诺福韦富马酸替诺福韦酯治疗时发生CHB相关性肝硬化且MELD得分≥15的患者。主要终点是第6个月的无移植生存期。第6个月的次要终点是移植MELD得分提高5分以上的无移植生存，MELD得分<15的无移植生存。
结果：

在999例肝硬化CHB患者中，有605例（60.6％）在第6个月实现了无移植生存，高MELD患者在第6个月的无移植生存率稳定在10％。在第6个月获得无移植生存的患者较年轻，基线时的MELD评分较低，丙氨酸转氨酶（ALT）较低，白蛋白较高。在605名无移植存活患者中，有276名（45.6％）的MELD得分提高了> 5分； 183（30.2％）的MELD得分提高1-5分； 146名（24.1％）没有改善或MELD评分恶化。此外，有321名（53.1％）无移植生存期的患者在第6个月的MELD得分<15。
结论：

在降低MELD得分的基础上，年轻，CHB相关性肝硬化的患者在接受6个月的抗病毒治疗后，更年轻，具有更高的白蛋白和更低的ALT更有可能实现无移植生存。

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关键字：

改善MELD；肝硬化无移植生存

PMID：
    32032974
DOI：
    10.1111 / jgh.15007