长期抗病毒治疗预测乙型肝炎相关肝硬化患者预后的因素

StephenW

Factors Predicting Outcomes of Hepatitis B-related Cirrhosis Patients With Long-Term Antiviral Therapy
Chih-Lin Lin  1 , Kuo-Chih Tseng  2 , Kuan-Yang Chen  3 , Li-Ying Liao  3 , Jia-Horng Kao  4
Affiliations
Affiliations

    1
    Department of Gastroenterology, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan; Department of Psychology, National Chengchi University, Taipei, Taiwan.
    2
    Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan; School of Medicine, Tzuchi University, Hualien, Taiwan.
    3
    Department of Gastroenterology, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan.
    4
    Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: [email protected].

    PMID: 32653388 DOI: 10.1016/j.jfma.2020.07.003

Abstract

Background/purpose: Long-term nucleos(t)ide analog (NA) therapy has been shown to improve the survival in patients with HBV-related cirrhosis. The aim of this study was to evaluate the clinical outcomes and factors associated with survival in HBV-related cirrhotic patients receiving long-term NA treatment.

Methods: A total of 126 HBV-related cirrhosis patients with long-term NA treatment, including 67 compensated cirrhosis and 59 decompensated cirrhosis, were retrospectively enrolled. The effectiveness of treatment, survival and risk factors of mortality were determined.

Results: Patients with decompensated cirrhosis had significantly lower baseline serum HBV DNA levels than compensated cirrhotic patients (4.98 ± 1.91 vs. 5.67 ± 1.26 log10 IU/ml, P = 0.031). The mean follow-up duration was 84 and 42 months in compensated cirrhotic and decompensated cirrhotic patients (P < 0.0001), respectively. The 1, 2 and 3-year cumulative survival rates were significantly higher in compensated cirrhotic patients than those with decompensated cirrhosis (100%, 98.5%, 98.5% vs. 81.2%, 75.6%, 69.5%; P < 0.0001). Multivariate analysis for risk factors of mortality in cirrhotic patients showed that older age (hazard ratio: 3.28, 95% CI: 1.25-8.62, P = 0.016) and decompensated cirrhosis (hazard ratio: 8.30, 95% CI: 2.45-28.06, P = 0.0007) were independently associated with liver-related mortality. A total of 31 patients developed HCC during the follow-up. Among them, 70.9% were at the earlier stages of BCLC system, and 83.8% received potentially curative treatment.

Conclusion: Antiviral therapy improves liver function of HBV-related cirrhotic patients and provides a better chance of curative treatment in those with HCC development. Decompensated cirrhosis is a risk factor for liver-related mortality in this special clinical setting.

Keywords: Decompensated cirrhosis; Hepatitis B virus; Hepatocellular carcinoma; Nucleos(t)ide analog.

Copyright © 2020 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

StephenW

长期抗病毒治疗预测乙型肝炎相关肝硬化患者预后的因素
林志霖1，曾国治2，陈宽阳3，廖丽颖3，高家鸿4
隶属关系
隶属关系

    1个
    台湾台北市仁爱分院台北市立医院消化内科；国立政治大学心理系，台湾台北。
    2
    台湾嘉义市佛教慈济医学基金会大林慈济医院内科；慈济大学医学院，台湾花莲。
    3
    台湾台北市仁爱分院台北市立医院消化内科。
    4
    国立台湾大学医学院临床医学研究所，台湾台北；国立台湾大学附属医院消化内科，消化内科，台湾台北国立台湾大学附属医院肝炎研究中心，台湾台北；国立台湾大学医院医学研究室，台湾台北。电子地址：[email protected]。

    PMID：32653388 DOI：10.1016 / j.jfma.2020.07.003

抽象

背景/目的：长期核苷酸类似物（NA）治疗已被证明可以改善HBV相关性肝硬化患者的生存率。这项研究的目的是评估接受长期NA治疗的HBV相关肝硬化患者的临床结局和与生存相关的因素。

方法：回顾性分析126例接受长期NA治疗的HBV相关性肝硬化患者，包括67例代偿性肝硬化和59例代偿性肝硬化。确定了治疗的有效性，生存率和死亡率的危险因素。

结果：失代偿性肝硬化患者的基线血清HBV DNA水平明显低于代偿性肝硬化患者（4.98±1.91对5.67±1.26 log10 IU / ml，P = 0.031）。肝硬化代偿期和失代偿期肝硬化患者的平均随访时间分别为84个月和42个月（P <0.0001）。代偿性肝硬化患者的1年，2年和3年累积生存率明显高于失代偿性肝硬化患者（100％，98.5％，98.5％与81.2％，75.6％，69.5％； P <0.0001）。肝硬化患者死亡危险因素的多变量分析显示，年龄较大（危险比：3.28，95％CI：1.25-8.62，P = 0.016）和失代偿性肝硬化（危险比：8.30，95％CI：2.45-28.06，P = 0.0007）与肝相关死亡率独立相关。随访期间共有31例患者发生了HCC。其中，70.9％处于BCLC系统的早期阶段，83.8％的患者接受了潜在的治疗。

结论：抗病毒治疗可改善HBV相关肝硬化患者的肝功能，并为HCC发生发展的患者提供更好的治愈机会。在这种特殊的临床环境中，代偿性肝硬化是肝相关死亡的危险因素。

关键字：代偿性肝硬化；乙型肝炎病毒;肝细胞癌；核苷酸类似物。

版权所有©2020福尔摩沙医学协会。由Elsevier B.V.发布。保留所有权利。

StephenW

https://www.sciencedirect.com/sc ... 20302928?via%3Dihub