未經治療的不確定期慢性乙型肝炎患者的自然史和肝細胞癌

StephenW

Natural History and Hepatocellular Carcinoma Risk in Untreated Chronic Hepatitis B Patients with Indeterminate Phase (117/120)

    Daniel Q. Huang ∗
    Xiaohe Li ∗
    Michael H. Le
    Ramsey C. Cheung
    Hwai-I Yang
    Mindie H. Nguyen
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Published:January 15, 2021DOI:https://doi.org/10.1016/j.cgh.2021.01.019


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Abstract
Background and aims
Many patients with chronic hepatitis B (CHB) may not conform to any of the defined phases, hence classified as indeterminate. We aimed to characterize the baseline prevalence of indeterminate patients and their natural history, phase transition and hepatocellular carcinoma (HCC) risk.
Methods
This is a retrospective cohort study of 3,366 adult untreated non-cirrhotic CHB patients seen at five U.S. clinics and seven Taiwanese townships who had at least one year of serial laboratory data prior to enrollment with a mean follow-up of 12.5 years. Patients’ clinical phases were determined at baseline and through serial data during follow-up, based on the AASLD 2018 Guidance.
Results
At baseline, 1,303 (38.7%) patients were in the indeterminate phase. By up to year 10 of follow-up, 686 patients (52.7%) patients remained indeterminate, while 283 (21.7%) became immune active. Compared to patients who remained inactive, patients who remained indeterminate had higher 10-year cumulative HCC incidence (4.6% vs. 0.5%, P<0.0001) and adjusted hazard ratio (HR) for HCC of 14.1 ( P=0.03). Among patients who remained indeterminate, age ≥ 45 years (adjusted HR 18.4, P=0.005) was independently associated with HCC development.
Conclusions
Nearly 40% of patients had indeterminate CHB phase. Of these, half remained indeterminate and one-fifth transitioned to the immune active phase. HCC risk in persistently indeterminate CHB was 14 times higher than inactive CHB. Among persistently indeterminate CHB patients, age ≥ 45 years was associated with 18 times higher risk for HCC development. Further studies are needed to evaluate the potential benefit of antiviral therapy for indeterminate patients, especially in the older subgroup.
Keywords

    Hepatitis B
    indeterminate
    natural history
    hepatocellular carcinoma

StephenW

未經治療的不確定期慢性乙型肝炎患者的自然史和肝細胞癌風險（117/120）

    丹尼爾·Q·黃*
    李小河
    邁克爾·H·勒
    張蘭芝
    楊懷愛
    Mindie H.阮
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發佈時間：2021年1月15日DOI：https：//doi.org/10.1016/j.cgh.2021.01.019


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抽象
背景和目標
許多患有慢性乙型肝炎（CHB）的患者可能不符合任何定義的階段，因此分類為不確定的。我們旨在表徵不確定患者的基線患病率及其自然史，相變和肝細胞癌（HCC）風險。
方法
這是一項回顧性隊列研究，對3366名未經治療的非肝硬化成人CHB患者在美國的5個診所和7個台灣鄉鎮進行了研究，他們在入組前至少有一年的連續實驗室數據，平均隨訪時間為12.5年。根據AASLD 2018指南，在基線和隨訪期間通過系列數據確定患者的臨床階段。
結果
基線時，有1,303（38.7％）名患者處於不確定期。截至隨訪的第10年，仍有686例患者（52.7％）處於不確定狀態，而283例（21.7％）的患者俱有免疫活性。與不活動的患者相比，不確定的患者10年累積HCC發生率更高（4.6％vs. 0.5％，P <0.0001），HCC調整後的危險比（HR）為14.1（P = 0.03）。在仍不確定的患者中，年齡≥45歲（校正後的HR 18.4，P = 0.005）與肝癌的發生獨立相關。
結論
將近40％的患者CHB期不確定。其中一半保持不確定狀態，五分之一過渡到免疫活性期。持續不確定的CHB的HCC風險比不活躍的CHB高14倍。在持續不確定的CHB患者中，年齡≥45歲與HCC發生風險高18倍相關。需要進一步的研究來評估抗病毒治療對不確定患者的潛在益處，尤其是在老年亞組中。
關鍵詞

    乙型肝炎
    不定
    自然歷史
    肝細胞癌