乙型肝炎病毒相关代偿性肝硬化的有或无核苷酸类似物治疗

StephenW

Long-term prognosis with or without nucleot(s)ide analogue therapy in hepatitis B virus-related decompensated cirrhosis
Takashi Kumada  1 , Hidenori Toyoda  2 , Satoshi Yasuda  2 , Nozomi Miyake  2 , Takanori Ito  3 , Junko Tanaka  4
Affiliations
Affiliations

    1
    Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Gifu, Japan.
    2
    Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
    3
    Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
    4
    Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan.

    PMID: 33306854 DOI: 10.1111/jvh.13457

Abstract

The development of nuleos(t)ide analogues (NAs) has dramatically changed the natural history of chronic hepatitis B virus (HBV) infection. In this study, we compared patients with HBV-related decompensated cirrhosis with and without NA therapy in terms of hepatocarcinogenesis and all-cause, liver-related, and non-liver-related mortality. This study enrolled 160 patients with decompensated cirrhosis, 78 of whom were treated with NA therapy (NA group) and 82 of whom were not (Non-NA group). Propensity score matching and inverse probability weighting were performed to adjust the baseline characteristics in the NA and Non-NA groups. Liver-related and non-liver-related mortality were analyzed using the competing risks IPW cumulative incidence functions estimator. The Cox proportional hazards model and the Fine and Gray proportional hazards model were used to analyze factors associated with hepatocarcinogenesis and all-cause, liver-related, and non-liver-related mortality. HBV DNA ≥20,000 IU/mL (adjusted hazard ratio, 8.440) and dyslipidemia (adjusted hazard ratio, 0.178) were independently associated with hepatocarcinogenesis. HBV DNA ≥20,000 IU/mL (adjusted hazard ratio, 4.360) and Non-NA group (adjusted hazard ratio 4.802) were independently associated with all-cause mortality. Diabetes mellitus (adjusted hazard ratio, 4.925), FIB-4 score >3.6 (adjusted hazard ratio, 4.151), Non-NA group (adjusted hazard ratio, 9.180), presence of dyslipidemia (adjusted hazard ratio, 0.182), and male gender (adjusted hazard ratio, 3.045) were independently associated with liver-related mortality. HBV DNA ≥20,000 IU/mL (adjusted hazard ratio, 3.216) and high age (adjusted hazard ratio, 2.692) were independently associated with non-liver-related mortality. Although the cumulative incidence rate of hepatocarcinogenesis and non-liver-related mortality was not reduced by NA therapy, viral suppression reduced liver-related mortality in patients with DC.

Keywords: decompensated cirrhosis; hepatitis B virus (HBV); hepatocellular carcinoma (HCC); liver-related mortality; nucleot(s)ide analogue.

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StephenW

乙型肝炎病毒相关代偿性肝硬化的有或无核苷酸类似物治疗的长期预后
熊田隆1，丰田秀典2，安田聪2，三宅希美2，伊藤忠典3，田中顺子4
隶属关系
隶属关系

    1个
    岐阜共立大学护理学系护理学系，日本岐阜县大垣市。
    2
    日本岐阜县大垣市大垣市立医院消化内科。
    3
    名古屋大学医学研究科胃肠病学和肝病学系，日本名古屋。
    4
    广岛大学生物医学与健康科学研究所流行病学，传染病控制与预防系，日本广岛。

    PMID：33306854 DOI：10.1111 / jvh.13457

抽象

nuleos（t）ide类似物（NAs）的发展极大地改变了慢性乙型肝炎病毒（HBV）感染的自然史。在这项研究中，我们比较了肝癌发生和全因，肝相关和非肝相关死亡率方面，有和无NA治疗的HBV相关代偿性肝硬化患者。这项研究招募了160例失代偿性肝硬化患者，其中78例接受了NA治疗（NA组），而82例未进行非NA治疗（Non-NA组）。进行倾向得分匹配和逆概率加权，以调整NA和Non-NA组的基线特征。使用竞争风险IPW累积发病率函数估算器分析了与肝有关和与非肝有关的死亡率。使用Cox比例风险模型和Fine和Grey比例风险模型分析与肝癌发生和全因，肝相关和非肝相关死亡率相关的因素。 HBV DNA≥20,000IU / mL（危险比调整后为8.440）和血脂异常（危险比调整后为0.178）与肝癌的发生独立相关。 HBV DNA≥20,000IU / mL（危险比调整后为4.360）和非NA组（危险比调整后为4.802）均与全因死亡率相关。糖尿病（风险调整率，4.925），FIB-4评分> 3.6（风险调整率，4.151），非NA组（风险调整率，9.180），血脂异常的存在（风险调整率，0.182），男性（调整后的危险比3.045）与肝脏相关的死亡率独立相关。 HBV DNA≥20,000IU / mL（危险比调整后为3.216）和高龄（危险比调整后为2.692）与非肝脏相关死亡率无关。尽管通过NA疗法并没有降低肝癌发生的累积发病率和非肝相关死亡率，但是病毒抑制降低了DC患者的肝相关死亡率。

关键词：失代偿性肝硬化；乙型肝炎病毒（HBV）；肝细胞癌（HCC）；肝脏相关死亡率；核苷酸类似物。

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