较低的MELD分数​​与乙型肝炎患者的无移植生存相关

StephenW

Lower MELD Scores Linked to Transplant-Free Survival in Hepatitis B Patients
FEBRUARY 28, 2020
Kenny Walter
@KwalterMDMag
Terry Cheuk-Fung Yip, PhD

Terry Cheuk-Fung Yip, PhD
It is well-known that Improvement in (MELD) scores during antiviral treatment is related to reduced hepatic decompensation and death in chronic hepatitis B (CHB) patients.

A team, led by Terry Cheuk-Fung Yip, PhD, Faculty of Medicine, Institute of Digestive Disease at The Chinese University of Hong Kong, Shatin, identified the factors linked to transplant-free survival and on-treatment Model for End-Stage Liver Disease (MELD) score improvement for patients with CHB-related cirrhosis.

The investigators identified patients with CHB-related cirrhosis and MELD score ≥ 15 at the start of entecavir and/or tenofovir disoproxil fumarate treatment between 2005-2017.

The team sought a primary endpoint of transplant-free survival after 6 months.

The investigators also sought secondary endpoints at month 5 of transplant-free survival with > 5‐point improvement in MELD score and transplant‐free survival with MELD score < 15.

The study included 999 cirrhotic CHB patients, 605 (60.6%) of which achieved transplant-free survival after 6 months. The proportion of transplant-free survival patients at 6 months stabilized at 10% in patients with high MELD.

The investigators also found patients who achieved transplant-free survival at month 6 were generally younger, with lower MELD scores, lower alanine aminotransferase (ALT), and higher albumin at baseline.

Of the 605 patients with transplant-free survival, 276 (45.6%) achieved > 5‐point improvement in MELD scores. An additional 183 (30.2%) patients had 1-5-point improvements in MELD, while 146 (24.1%) had no improvement or a worsened MELD scores . Also, 321 (53.1%) patients with transplant-free survival had a MELD score < 15 at month 6.

“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,” the authors wrote.

Patients with diabetes generally have an increased risk for developing various forms of liver diseases that can cause or exacerbate diabetes, including HBV and hepatitis C virus (HCV) infections. Diabetes can also cause or intensify the severity of liver infections.

In a cross-sectional study, investigators, led by Yihenew Million, University of Gondar, determined the prevalence of both HBV and HCV infections and identified the associated factors among patients with diabetes visiting the University of Gondar referral teaching hospital in Ethiopia between 2016-2017.

The investigators examined 610 patients, half of which had diabetes in the study and found 65 (10.7%) were positive for either hepatitis infection, of which 44 (14.4%) and 21 (6.9%) were positive for at least 1 of the viruses in patients with diabetes and people with no diabetes, respectively.

Out of the diabetic and non-diabetic groups of the study, 26 (8.5%) and 14 (4.6%) (95% CI, .96–4.02) were positive for Hepatitis B virus, respectively, while 23 (7.5%) and 7 (2.3%) (95% CI, 1.46–8.68) of the diabetes and non-diabetic groups were positive for Hepatitis C virus, respectively.

“Positivity for Hepatitis C virus was significantly associated with Type II diabetes,” the authors wrote. “Blood transfusion and unprotected sex were risk factors for Hepatitis B virus infections.”

The study, “Factors associated with improvement in MELD score after antiviral treatment in patients with chronic hepatitis B,” was published online in the Journal of Gastroenterology and Hepatology.

StephenW

较低的MELD分数​​与乙型肝炎患者的无移植生存相关
2020年2月28日
肯尼·沃尔特
@KwalterMDMag
叶德丰博士

叶德丰博士
众所周知，抗病毒治疗期间（MELD）分数的提高与慢性乙型肝炎（CHB）患者的肝失代偿和死亡减少有关。

沙田香港中文大学消化疾病研究所医学系叶德丰博士领导的一个研究小组确定了与无移植生存和终末期肝治疗模型相关的因素CHB相关性肝硬化患者的疾病（MELD）评分提高。

研究人员确定了2005-2017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开始时CHB相关性肝硬化且MELD≥15的患者。

该小组寻求6个月后无移植生存的主要终点。

研究人员还寻求无移植生存期第5个月的次要终点，MELD评分提高了5分以上，MELD得分<15则无移植生存期提高了。

该研究包括999名肝硬化CHB患者，其中605名（60.6％）在6个月后获得了无移植生存。高MELD患者在6个月时无移植存活患者的比例稳定在10％。

研究人员还发现，在第6个月实现无移植生存的患者通常较年轻，MELD评分较低，丙氨酸氨基转移酶（ALT）较低，基线时白蛋白较高。

在605例无移植生存的患者中，有276例（45.6％）的MELD得分提高了5分以上。另有183名（30.2％）患者的MELD改善了1-5分，而146名（24.1％）患者的MELD则没有改善或恶化。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。

作者写道：“除了较低的MELD分数​​外，年轻，CHB相关性肝硬化的患者更年轻，白蛋白更高，ALT更低，在经过6个月的抗病毒治疗后更有可能实现无移植生存。”

糖尿病患者通常患各种形式的肝脏疾病（包括HBV和丙型肝炎病毒（HCV）感染）的风险增加，这些疾病可能导致或加剧糖尿病。糖尿病也会引起或加剧肝脏感染的严重性。

在一项横断面研究中，由贡德尔大学Yihenew Million领导的研究人员确定了2016-2017年间在埃塞俄比亚贡达尔大学转诊教学医院就诊的糖尿病患者中HBV和HCV感染的患病率，并确定了相关因素。

研究人员检查了610名患者，其中一半在研究中患有糖尿病，发现65例（10.7％）肝炎感染呈阳性，其中44例（14.4％）和21例（6.9％）至少一种病毒呈阳性糖尿病患者和非糖尿病患者分别使用。

在该研究的糖尿病和非糖尿病组中，分别有26（8.5％）和14（4.6％）（95％CI，.96–4.02）的乙型肝炎病毒阳性，而23（7.5％）和糖尿病和非糖尿病组分别有7（2.3％）（95％CI，1.46--8.68）丙型肝炎病毒阳性。

作者写道：“丙型肝炎病毒的阳性率与II型糖尿病显着相关。” “输血和无保护的性行为是乙型肝炎病毒感染的危险因素。”

这项研究“与慢性乙型肝炎患者抗病毒治疗后MELD评分改善相关的因素”在线发表在《胃肠病学和肝病学杂志》上。

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