慢性乙型肝炎患者肝细胞癌的二级预防：所有核苷酸（t）ide

StephenW

Secondary prevention for hepatocellular carcinoma in patients with chronic hepatitis B: are all the nucleos(t)ide analogues the same?

    Terry Cheuk-Fung Yip, Jimmy Che-To Lai & Grace Lai-Hung Wong

Journal of Gastroenterology volume 55, pages1023–1036(2020)Cite this article

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Abstract

Reducing the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) is the key ultimate goal set in essentially all treatment guidelines. There has been solid evidence supporting the relationship between serum hepatitis B virus (HBV) DNA level and risk of HCC. Antiviral treatment with oral nucleos(t)ide analogues (NAs) leads to sustained viral suppression and hence is often adopted as the secondary prevention for HCC in CHB patients. The first-generation NA, lamivudine, reduced the risk of HCC at 3 years compared to placebo; yet, its high emergence of antiviral resistance has made it no longer recommended in the international guidelines. Recent heated debate is about the two current first-line NAs—entecavir and tenofovir disoproxil fumarate (TDF)—Are they just as good to reduce HCC risk in CHB patients? A handful of cohort studies show two different kinds of observations—TDF is better than entecavir in lowering HCC risk, or these two NAs have led to similarly low risk of HCC. Tenofovir alafenamide (TAF), a modified version of TDF higher rate of ALT normalization, would be another potent nucleotide analogue is the treatment of choice for secondary prevention for HCC.

StephenW

慢性乙型肝炎患者肝细胞癌的二级预防：所有核苷酸（t）ide类似物是否相同？

    叶德丰，叶志敏＆黄丽红

胃肠病学杂志第55卷，第1023–1036页（2020年）

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抽象

降低所有慢性乙型肝炎（CHB）患者的肝细胞癌（HCC）发病率是基本上所有治疗指南中设定的关键最终目标。有确凿的证据支持血清乙型肝炎病毒（HBV）DNA水平与HCC风险之间的关系。口服核苷酸类似物（NAs）的抗病毒治疗可导致持续的病毒抑制，因此常被用作CHB患者HCC的二级预防。与安慰剂相比，第一代NA拉米夫定可降低3年时发生HCC的风险；然而，其抗病毒耐药性的高度出现使得它不再被国际准则所推荐。最近激烈的辩论是关于目前的两种一线NAs-恩替卡韦和替诺福韦富马酸替诺福韦酯（TDF），它们是否同样可以降低CHB患者的HCC风险？少数队列研究显示了两种不同的观察结果：TDF在降低HCC风险方面比恩替卡韦更好，或者这两个NA导致了类似的低HCC风险。 Tenofovir alafenamide（TAF）是TDF ALT正常化率更高的改良版，将是另一种有效的核苷酸类似物，是HCC二级预防的治疗选择。

StephenW

https://link.springer.com/articl ... c_springer_20201017