未经治疗的不确定期慢性乙型肝炎患者的自然史和肝细胞癌

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
    Show all authors
    Show footnotes

Published:January 15, 2021DOI:https://doi.org/10.1016/j.cgh.2021.01.019
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

未经治疗的不确定期慢性乙型肝炎患者的自然史和肝细胞癌风险（117/120）

    丹尼尔·Q·黄*
    李小河
    迈克尔·H·勒
    张兰芝
    杨怀爱
    Mindie H.阮
    显示所有作者
    显示脚注

发布时间：2021年1月15日DOI：https：//doi.org/10.1016/j.cgh.2021.01.019
抽象
背景和目标
许多患有慢性乙型肝炎（CHB）的患者可能不符合任何定义的阶段，因此分类为不确定的。我们旨在表征不确定患者的基线患病率及其自然史，相变和肝细胞癌（HCC）风险。
方法
这是一项回顾性队列研究，对3366名未经治疗的非肝硬化成人CHB患者在美国的5个诊所和7个台湾乡镇进行了研究，他们在入组前至少有一年的连续实验室数据，平均随访时间为12.5年。根据AASLD 2018指南，在基线和随访期间通过系列数据确定患者的临床阶段。
结果
基线时，有1,303（38.7％）名患者处于不确定期。截至随访的第10年，仍有686例患者（52.7％）处于不确定状态，而283例（21.7％）的患者具有免疫活性。与不活动的患者相比，不确定的患者10年累积HCC发生率更高（4.6％vs. 0.5％，P <0.0001），HCC调整后的危险比（HR）为14.1（P = 0.03）。在仍不确定的患者中，年龄≥45岁（校正后的HR 18.4，P = 0.005）与肝癌的发生独立相关。
结论
将近40％的患者CHB期不确定。其中一半保持不确定状态，五分之一过渡到免疫活性期。持续不确定的CHB的HCC风险比不活跃的CHB高14倍。在持续不确定的CHB患者中，年龄≥45岁与HCC发生风险高18倍相关。需要进一步的研究来评估抗病毒治疗对不确定患者的潜在益处，尤其是在老年亚组中。
关键词

    乙型肝炎
    不定
    自然历史
    肝细胞癌