自发的或核苷酸类似物诱导的乙型肝炎表面抗原丧失后，肝

StephenW

Similarly low risk of hepatocellular carcinoma after either spontaneous or nucleos(t)ide analogue-induced hepatitis B surface antigen loss
Terry Cheuk-Fung Yip  1   2   3 , Vincent Wai-Sun Wong  1   2   3 , Yee-Kit Tse  1   2   3 , Lilian Yan Liang  1 , Vicki Wing-Ki Hui  1 , Xinrong Zhang  1 , Guan-Lin Li  1 , Grace Chung-Yan Lui  1   2 , Henry Lik-Yuen Chan  1   2   3 , Grace Lai-Hung Wong  1   2   3
Affiliations
Affiliations

    1
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
    2
    Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China.
    3
    Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.

    PMID: 33222272 DOI: 10.1111/apt.16174

Abstract

Background: It is unknown whether patients with chronic hepatitis B (CHB) who achieved hepatitis B surface antigen (HBsAg) seroclearance spontaneously or following anti-viral therapy have similar clinical outcomes.

Aim: To compare the risk of hepatocellular carcinoma (HCC) in patients with CHB who either cleared HBsAg spontaneously or following anti-viral therapy METHODS: Adult CHB-monoinfected patients who cleared HBsAg between January 2000 and March 2019 were identified from a territory-wide database in Hong Kong. Patients with liver transplantation and/or HCC before HBsAg loss were excluded. Patients' demographics, comorbidities, anti-viral treatment, laboratory parameters and HCC development were analysed.

Results: Of 7,124 identified patients with CHB who cleared HBsAg, mean age was 58.1 ± 13.8 years; 4,340 (60.9%) were male; 451 (6.3%) had cirrhosis; 5,917 (83.1%) and 1,207 (16.9%) had spontaneous and nucleos(t)ide analogue (NA)-induced HBsAg seroclearance, respectively. Most patients had normal liver function at HBsAg loss. Patients with NA-induced HBsAg seroclearance were younger, and more likely to be male and cirrhotic than patients with spontaneous HBsAg loss. At a median (interquartile range) follow-up of 4.3 (2.2-7.6) years, 97 (1.6%) and 16 (1.3%) patients with spontaneous and NA-induced HBsAg loss developed HCC, respectively. Patients who achieved NA-induced HBsAg loss had comparable HCC risk as those with spontaneous HBsAg loss (adjusted subdistribution hazard ratio 0.75, 95% CI 0.43-1.32, P = 0.323). The results remained robust in propensity score weighting and matching analyses.

Conclusion: The HCC risk was similarly low after either spontaneous or NA-induced HBsAg seroclearance in a territory-wide cohort of patients with CHB who had cleared HBsAg.

© 2020 John Wiley & Sons Ltd.

StephenW

自发的或核苷酸类似物诱导的乙型肝炎表面抗原丧失后，肝细胞癌的风险同样低
叶德丰1 2 3，黄文顺1 2 3 3，谢绮洁1 2 3，阎丽莲1，惠咏琪1，张新荣1，李冠林1，race婉婷-吕仁（Yan Lui）1 2，陈力源（Henry Lik-Yuen）1 2 3，王丽丽（Grace Lai-Hung）1 2 3
隶属关系
隶属关系

    1个
    香港中文大学，香港特别行政区医学与治疗学系。
    2
    香港中文大学，香港中国医学数据分析中心（MDAC）。
    3
    香港中文大学医学院消化病研究所，香港特别行政区。

    PMID：33222272 DOI：10.1111 / apt.16174

抽象

背景：尚不清楚是否自然而然地或在抗病毒治疗后达到乙型肝炎表面抗原（HBsAg）血清清除率的慢性乙型肝炎（CHB）患者是否具有相似的临床结果。

目的：比较自发清除HBsAg或接受抗病毒治疗的CHB患者的肝细胞癌（HCC）风险方法：从2000年1月至2019年3月之间，从成人中分离出HBsAg的成人CHB单一感染患者香港的数据库。 HBsAg丢失前接受肝移植和/或HCC的患者被排除在外。分析患者的人口统计学，合并症，抗病毒治疗，实验室参数和肝癌的发展。

结果：在7124名经确认的CHB患者中清除了HBsAg，平均年龄为58.1±13.8岁。男性4,340（60.9％）； 451名（6.3％）患有肝硬化； 5,917（83.1％）和1,207（16.9％）分别具有自发的和核苷酸类似物（NA）诱导的HBsAg血清清除。大多数患者在HBsAg丢失时肝功能正常。 NA引起的HBsAg血清清除的患者比自发性HBsAg丢失的患者年轻，男性和肝硬化的可能性更高。在4.3（2.2-7.6）年的中位（四分位间距）随访中，分别有97（1.6％）和16（1.3％）位自发和NA诱导的HBsAg丢失患者发展为HCC。 NA引起的HBsAg丧失的患者与自发性HBsAg丧失的患者具有相当的HCC风险（调整后的亚分布危险比0.75，95％CI 0.43-1.32，P = 0.323）。结果在倾向得分加权和匹配分析中仍然很稳健。

结论：在全港范围内已清除HBsAg的CHB患者队列中，自发或NA诱导的HBsAg血清清除后，HCC风险同样较低。

分级为4 +©2020 John Wiley＆Sons Ltd.