在慢性乙型肝炎患者中，血清乙型肝炎病毒DNA的中等水平与

StephenW

Aliment Pharmacol Ther. 2020 Apr 14. doi: 10.1111/apt.15725. [Epub ahead of print]
Moderate levels of serum hepatitis B virus DNA are associated with the highest risk of hepatocellular carcinoma in chronic hepatitis B patients.
Kim GA1,2, Han S3, Choi GH1,4, Choi J1, Lim YS1.
Author information

1
    Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
2
    Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
3
    Department of Applied Statistics, Gachon University, Seongnam, Republic of Korea.
4
    Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.

Abstract
BACKGROUND:

Studies have shown a higher risk of hepatocellular carcinoma (HCC) with higher baseline serum hepatitis B virus (HBV) DNA levels in chronic hepatitis B (CHB) patients. However, the association between very high HBV DNA levels (>6 log10 IU/mL) and HCC risk remains unclear, especially in middle-aged and old HBeAg-positive patients.
AIM:

To identify the association between broad-range HBV DNA levels and HCC risk.
METHODS:

We conducted a historical cohort study in Korea involving 6949 non-cirrhotic, treatment-naïve CHB patients with alanine aminotransferase (ALT) <2× upper limit of normal for >1 year. HBV DNA was >6 log10 IU/mL in 2029 (29.2%) patients. Follow-up was censored when the antiviral therapy was initiated.
RESULTS:

The mean age of the patients was 45 years. During 8.0 years of median follow-up, 363 patients (5.2%) developed HCC. By multivariable Cox regression analysis, HCC risk was highest with baseline HBV DNA levels of 6-7 log10 IU/mL (adjusted hazard ratio [aHR] 4.98; P < 0.001), and lowest with >8 log10 IU/mL (aHR 0.90; P = 0.71) and ≤4 log10 IU/mL (aHR 1.00; reference), which was independent of other predictive factors. The similar association between HBV DNA levels and HCC risk was consistently observed in all age subgroups (age <40, 40-49 and ≥ 50 years).
CONCLUSIONS:

HCC risk was highest with moderate serum HBV DNA levels of 6-7 log10 IU/mL in CHB patients without significant ALT elevation. Extending treatment indication to CHB patients with moderate levels of HBV DNA may be considered to further prevent HCC, regardless of ALT levels.

© 2020 John Wiley & Sons Ltd.

PMID:
    32291781
DOI:
    10.1111/apt.15725

StephenW

食品药理学。 2020年4月14日。doi：10.1111 / apt.15725。 [Epub提前发行]
在慢性乙型肝炎患者中，血清乙型肝炎病毒DNA的中等水平与肝细胞癌的最高风险相关。
Kim GA1,2，Han S3，Choi GH1,4，Choi J1，Lim YS1。
作者信息

1个
    韩国首尔蔚山大学医学院附属牙山医学中心，肝病中心，消化内科。
2
    韩国首尔庆熙大学医学院内科。
3
    韩国城南加川大学应用统计系。
4
    韩国首尔国立首尔大学医学院附属首尔国立大学盆唐医院内科。

抽象
背景：

研究表明，在慢性乙型肝炎（CHB）患者中，基线血清乙型肝炎病毒（HBV）DNA水平较高时，肝细胞癌（HCC）的风险较高。但是，尚不清楚HBV DNA水平很高（> 6 log10 IU / mL）与HCC风险之间的相关性，特别是在中老年HBeAg阳性患者中。
目标：

确定广泛的HBV DNA水平与HCC风险之间的关联。
方法：

我们在韩国进行了一项历史性队列研究，研究对象是6949名丙肝转氨酶（ALT）<正常正常上限的2倍且未接受过治疗的初治CHB的患者，> 1年。 2029年（29.2％）患者的HBV DNA> 6 log10 IU / mL。当开始抗病毒治疗时，对随访进行检查。
结果：

患者的平均年龄为45岁。在中位随访8.0年中，有363例患者（5.2％）发展为HCC。通过多变量Cox回归分析，基线HBV DNA水平为6-7 log10 IU / mL时，HCC风险最高（调整后的危险比[aHR] 4.98； P <0.001），> 8 log10 IU / mL（aHR 0.90；最低）。 P = 0.71）且≤4log10 IU / mL（aHR 1.00；参考），与其他预测因素无关。在所有年龄亚组（年龄<40、40-49和≥50岁）中，始终观察到HBV DNA水平与HCC风险之间存在相似的关联。
结论：

在没有明显ALT升高的CHB患者中，中度血清HBV DNA水平为6-7 log10 IU / mL时，HCC风险最高。无论ALT水平如何，都可以考虑将治疗适应症扩展至HBV DNA水平中等的CHB患者，以进一步预防HCC。

分级为4 +©2020 John Wiley＆Sons Ltd.

PMID：
    32291781
DOI：
    10.1111 / apt.15725