慢性乙型肝炎免疫耐受期患者肝细胞癌发展的极低风险

StephenW

Aliment Pharmacol Ther

. 2020 May 26.
doi: 10.1111/apt.15741. Online ahead of print.
Extremely Low Risk of Hepatocellular Carcinoma Development in Patients With Chronic Hepatitis B in Immune-Tolerant Phase
Han Ah Lee  1 , Hyun Woong Lee  2 , In Hee Kim  3 , Soo Young Park  4 , Dong Hyun Sinn  5 , Jung Hwan Yu  6 , Yeon Seok Seo  1 , Soon Ho Um  1 , Jung Il Lee  2 , Kwan Sik Lee  2 , Chang Hun Lee  3 , Won Young Tak  4 , Young Oh Kweon  4 , Wonseok Kang  5 , Yong-Han Paik  5 , Jin-Woo Lee  6 , Sang Jun Suh  7 , Young Kul Jung  7 , Beom Kyung Kim  8   9 , Jun Yong Park  8   9 , Do Young Kim  8   9 , Sang Hoon Ahn  8   9 , Kwang-Hyub Han  8   9 , Hyung Joon Yim  7 , Seung Up Kim  8   9
Affiliations

    PMID: 32452564 DOI: 10.1111/apt.15741

Abstract

Background: Anti-viral therapy is not indicated for patients with chronic hepatitis B (CHB) in the immune-tolerant phase.

Aims: To investigate the cumulative incidence of phase change and hepatocellular carcinoma (HCC) and independent predictors for phase change in patients with CHB in immune-tolerant phase.

Methods: In total, 946 patients in immune-tolerant phase, defined as hepatitis B e antigen positivity, HBV-DNA >20 000 IU/mL and alanine aminotransferase (ALT) ≤40 IU/L, between 1989 and 2017 were enrolled from eight institutes.

Results: The mean age of study population (429 men and 517 women) was 36.7 years. The mean ALT and HBV-DNA levels were 24.6 IU/L and 8.50 log10 IU/mL, respectively. Of the study population, 476 (50.3%) patients remained in immune-tolerant phase throughout the study period (median: 63.6 months). The cumulative incidence rates of phase change and HCC at 10 years were 70.7% and 1.7%, respectively. Multivariate analyses revealed that HBV-DNA level >107 IU/mL was associated independently with a reduced risk of phase change (hazard ratio [HR] = 0.734, P = 0.008), whereas a high ALT level, above the cut-off recommended in the Korean Association for the Study of the Liver guidelines (34 IU/L for men and 30 IU/L for women), was associated independently with a greater risk of phase change (HR = 1.885, P < 0.001).

Conclusions: The criterion of HBV-DNA level > 107 IU/mL may be useful to define immune-tolerant phase. In addition, an extremely low risk of HCC development was observed in patients with CHB in immune-tolerant phase.

© 2020 John Wiley & Sons Ltd.

StephenW

食品药理学

。 2020年5月26日。
doi：10.1111 / apt.15741。在线印刷。
慢性乙型肝炎免疫耐受期患者肝细胞癌发展的极低风险
Han Ah Lee 1，Hyun Woong Lee 2，In Hee Kim 3，Soo Young Park 4，Dong Hyun Sinn 5，Jung Hwan Yu 6，Yen Seok Seo 1，Soon Ho Um 1，Jung Il Lee 2，Kwan Sik Lee 2，李昌勋3，元英德4，杨小权4，元锡康5，容汉汉5，李金宇6，桑俊秀7，杨家荣7，朴庆金8 9，俊勇公园8 9，Do Young Kim 8 9，Sang Hoon Hohn 8 9，Kwang-Hyub Han 8 9，Hyung Joon Yim 7，Seung Up Kim 8 9
隶属关系

    PMID：32452564 DOI：10.1111 / apt.15741

抽象

背景：对于处于免疫耐受阶段的慢性乙型肝炎（CHB）患者，未建议使用抗病毒治疗。

目的：调查免疫耐受期CHB患者的相变和肝细胞癌（HCC）的累积发生率以及相变的独立预测因子。

方法：从1989年至2017年，总共946例1989年至2017年之间的946例免疫耐受期患者被定义为乙型肝炎e抗原阳性，HBV-DNA> 20000 IU / mL和丙氨酸转氨酶（ALT）≤40IU / L。研究所。

结果：研究人群的平均年龄（429名男性和517名女性）为36.7岁。 ALT和HBV-DNA的平均水平分别为24.6 IU / L和8.50 log10 IU / mL。在整个研究期间（中位数：63.6个月），有476名（50.3％）患者处于免疫耐受阶段。 10年时相变和HCC的累积发生率分别为70.7％和1.7％。多变量分析表明，> 107 IU / mL的HBV-DNA水平与降低相变风险独立相关（危险比[HR] = 0.734，P = 0.008），而较高的ALT水平高于建议的临界值。韩国肝脏研究协会指南（男性为34 IU / L，女性为30 IU / L）与相变风险更大相关（HR = 1.885，P <0.001）。

结论：HBV-DNA水平> 107 IU / mL的标准可能有助于确定免疫耐受期。此外，在免疫耐受期的CHB患者中观察到HCC发生的风险极低。

©2020 John Wiley＆Sons Ltd.

StephenW

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/apt.15741

齐欢畅