AASLD2020[748]预处理基线病毒之间的关联 肝细胞的负荷和治疗

StephenW

748
ASSOCIATION BETWEEN PRETREATMENT BASELINE VIRAL
LOAD AND ON-TREATMENT RISK OF HEPATOCELLULAR
CARCINOMA IN CHRONIC HEPATITIS B
Won-Mook Choi1, Gi-Ae Kim2, Jonggi Choi1, Seungbong Han3
and Young-Suk Lim1, (1)Department of Gastroenterology,
Asan Medical Center, University of Ulsan College of Medicine,
(2)Department of Internal Medicine, Kyung Hee University
Hospital, (3)Department of Applied Statistics, Gachon
University
Background: In patients with chronic hepatitis B (CHB),
hepatocellular carcinoma (HCC) risk persists despite antiviral
therapy The association between baseline serum HBV DNA
levels and on-treatment HCC risk remains unclear Methods:
In this multicenter historical cohort study in Korea, HCC risk
was analyzed in 3,541 entecavir- or tenofovir-treated noncirrhotic
adult patients with CHB by Cox proportional-hazards
regression HBV DNA level was analyzed as a categorical
variable Results: During 5 3 years of median follow-up,
100 patients developed HCC (0 50 per 100 person-years)
Baseline HBV DNA level was independently associated with
HCC risk in a non-linear parabolic pattern By multivariable
analysis, HCC risk was highest with HBV DNA levels 5 00–
5 99 log10 IU/mL (adjusted hazard ratio [aHR], 3 50; P<0 001),
followed by 6 00–6 99 log10 IU/mL (aHR, 3 04; P=0 001), and
3 30–4 99 log10 IU/mL (aHR, 1 87; P=0.17), with ≥8.00 log10
IU/mL showing the lowest HCC risk (aHR, 1 00; reference)
When the patients were stratified by FIB-4 index, compared
with baseline HBV DNA levels ≥8.00 log10 IU/mL, aHR for
HCC risk with HBV DNA levels 5 00–5 99 log10 IU/mL was
9 80 (P=0 006) if the patients had FIB-4 index <1 8, while
it was 2 47 (P=0.03) with FIB-4 index ≥1.8. Conclusion:
Pretreatment baseline HBV DNA levels were significantly
associated with HCC risk in a non-linear parabolic pattern in
CHB patients during long-term antiviral treatment, especially
with no significant hepatic fibrosis. Early antiviral intervention
before progressing to moderate viral load, that is associated
with irreversibly increased HCC risk, may optimize HCCpreventive
effect in non-cirrhotic adult CHB patients,
regardless of alanine aminotransferase levels and hepatic
fibrosis.

StephenW

748
预处理基线病毒之间的关联
肝细胞的负荷和治疗风险
慢性乙型肝炎的癌变
崔元-1，金基爱2，崔钟基1，韩承峰3
和Young-Suk Lim1，（1）消化内科，
蔚山大学医学院牙山医学中心
（2）庆熙大学内科学系
医院（3）加川市应用统计系
大学
背景：在慢性乙型肝炎（CHB）患者中，
尽管有抗病毒药物，肝细胞癌（HCC）的风险仍然存在
治疗基线血清HBV DNA之间的关联
的水平和治疗中的HCC风险仍不清楚方法：
在韩国的这项多中心历史队列研究中，HCC风险
在3,541种恩替卡韦或替诺福韦治疗的非肝硬化患者中进行了分析
成人慢性乙型肝炎患者的考克斯比例风险
回归分析HBV DNA水平被归类为
结果各异：在5到3年的中位随访期间，
100例患了HCC（每100人年为0 50）
基线HBV DNA水平与
非线性抛物线模式中的HCC风险
分析，HBV DNA水平5 00–
5 99 log10 IU / mL（调整的危险比[aHR]，3 50; P <0 001），
其次是6 00–6 99 log10 IU / mL（aHR，3 04; P = 0 001），和
3 30–4 99 log10 IU / mL（aHR，1 87; P = 0.17），≥8.00 log10
IU / mL显示最低的HCC风险（aHR，1 00；参考）
当患者按FIB-4指数分层时，进行比较
基线HBV DNA水平≥8.00log10 IU / mL，aHR为
HBV DNA水平为5 00–5 99 log10 IU / mL的HCC风险为
如果患者的FIB-4指数<1 8，则为9 80（P = 0 006），而
FIB-4指数≥1.8为2 47（P = 0.03）。结论：
治疗前基线HBV DNA水平显着
呈非线性抛物线型与肝癌风险相关
CHB患者在长期抗病毒治疗期间，尤其是
没有明显的肝纤维化。早期抗病毒干预
在发展到中等病毒载量之前
不可逆转地增加了HCC风险，可以优化HCC预防
对非肝硬化成人CHB患者的疗效，
不管丙氨酸氨基转移酶水平和肝
纤维化。