接受抗病毒治疗的慢性乙型肝炎肝硬化患者的肝代偿失调

StephenW

Hepatic decompensation in cirrhotic patients receiving antiviral therapy for chronic hepatitis B

    Hye Won Lee
    Terry Cheuk-Fung Yip
    Yee-Kit Tse
    Henry Lik-Yuen Chan
    Sang Hoon Ahn
    Vincent Wai-Sun Wong
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Published:September 01, 2020DOI:https://doi.org/10.1016/j.cgh.2020.08.064
Abstract
Objectives
It is unclear if anti-hepatitis B virus (HBV) treatment can eliminate incident hepatic decompensation. Here we report the incidence and predictors of hepatic decompensation among cirrhotic patients receiving antiviral therapy for chronic hepatitis B.
Methods
This is a post hoc analysis of two prospective HBV cohorts from Hong Kong and South Korea. Patients with liver stiffness measurement (LSM) ≥10 kPa and compensated liver disease at baseline were included. The primary endpoint was incident hepatic decompensation (jaundice or cirrhotic complications) with competing risk analysis.
Results
818 patients (mean age, 54.9 years; 519 male [63.4%]) were included in the final analysis. During a mean follow-up of 58.1 months, 32 (3.9%) patients developed hepatic decompensation, among whom 34% were secondary to HCC. Three (0.4%) patients experienced variceal bleeding alone, 27 (3.3%) had non-bleeding decompensation and 13 (1.6%) had more than 2 decompensating events Baseline LSM, diabetes, alanine aminotransferase, platelet, total bilirubin, albumin, prothrombin time, and eGFR were independent predictors of hepatic decompensation. 30/506 (5.9%) patients fulfilling the Baveno VI criteria (LSM ≥20 kPa and/or platelet count <150ⅹ10 9/L) and 2/312 (0.6%) patients not fulfilling the criteria developed hepatic decompensation ( P<0.001).
Conclusions
Hepatic decompensation is uncommon but not eliminated in patients receiving antiviral therapy for HBV-related cirrhosis, and only a third of decompensating events are secondary to HCC. The Baveno VI criteria, which was originally designed to detect varices needing treatment, can be effectively applied in this population to identify patients at risk of decompensation.
Keywords

    cirrhosis
    decompensation
    competing risk
    antiviral therapy

StephenW

接受抗病毒治疗的慢性乙型肝炎肝硬化患者的肝代偿失调

    李慧媛
    叶国锋
    谢怡洁
    陈力源
    桑勋安
    黄文顺
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发布时间：2020年9月1日DOI：https：//doi.org/10.1016/j.cgh.2020.08.064
抽象
目标
目前尚不清楚抗乙型肝炎病毒（HBV）的治疗方法是否可以消除突发性肝失代偿。在这里，我们报告了接受抗病毒治疗的慢性乙型肝炎的肝硬化患者中肝代偿失调的发生率和预测因素。
方法
这是对来自香港和韩国的两个预期HBV队列的事后分析。包括肝硬度测量值（LSM）≥10 kPa且基线时出现代偿性肝病的患者。主要终点是发生肝失代偿（黄疸或肝硬化并发症）并进行竞争性风险分析。
结果
最终分析包括818例患者（平均年龄54.9岁； 519例男性[63.4％]）。在58.1个月的平均随访期间，有32名（3.9％）患者发生了肝代偿失调，其中34％的患者继发于HCC。 3例（0.4％）患者仅经历了静脉曲张破裂出血，27例（3.3％）发生了无出血失代偿，13例（1.6％）发生了超过2例失代偿事件基线LSM，糖尿病，丙氨酸转氨酶，血小板，总胆红素，白蛋白，凝血酶原时间和eGFR是肝脏代偿失调的独立预测因子。符合Baveno VI标准（LSM≥20kPa和/或血小板计数<150ⅹ109 / L）的30/506（5.9％）患者和不符合该标准的2/312（0.6％）患者发生肝失代偿（P <0.001） 。
结论
在接受抗病毒治疗的HBV相关性肝硬化患者中，肝代偿失调很少见，但并未消除，只有三分之一的代偿失调事件是继发于HCC的。最初旨在检测需要治疗的静脉曲张的Baveno VI标准可以有效地应用于这一人群，以识别有失代偿风险的患者。
关键词

    肝硬化
    失代偿
    竞争风险
    抗病毒治疗