乙肝病毒抗病毒治疗可降低肝硬化风险

StephenW

HBV antiviral treatment linked with reduced cirrhosis risk
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Patients with chronic hepatitis B who received antiviral therapy experienced a significant reduction in risk for cirrhosis, according to study results.

“Few studies have specifically focused on the benefits of HBV antiviral therapies in non-Asian and noncirrhotic cohorts, especially as it relates to evaluating the impact of treatment on the risk of developing cirrhosis and death,” Robert J. Wong, MD, from Veterans Affairs Palo Alto Healthcare System, and colleagues wrote. “Furthermore, limited studies exist specifically focusing on safety-net and vulnerable populations, cohorts in whom it is particularly important to understand treatment benefits given existing disparities in timely access to HBV therapies and a disproportionately greater burden of advanced liver disease.”

Researchers analyzed data from 4,064 patients with chronic HBV from four safety-net health systems from 2010 to 2018. They evaluated the impact of HBV treatment on risk for cirrhosis, hepatocellular carcinoma, death, and composite of cirrhosis, HCC or death.

In the patient cohort, more than 51% were women, 42% were aged younger than 45 years, 31.6% were Black, 26.7% were Asian and 26.7% were Hispanic. Additionally, 23.2% received HBV antiviral therapy and 76.8% did not.

In a propensity score-match cohort that included 428 patients who received treatment and 428 who did not, treatment for chronic HBV was associated with lower risk for cirrhosis (HR = 0.67; 95% CI, 0.46-0.92) and composite cirrhosis, HCC or death (HR = 0.67; 95% CI, 0.49-0.94). Researchers found that women had lower risk than men, while Black patients had lower risk than non-Hispanic white patients.

After stratifying patients by age, sex and ethnicity, Wong and colleagues found that Asian women aged younger than 45 years had the greatest benefit from antiviral treatment.

“Our propensity score–matched analysis of noncirrhotic CHB patients across four urban safety-net health systems demonstrated significant reductions in risk of liver-related outcomes as a result of HBV antiviral therapies, driven primarily by the decreased risk of incident cirrhosis,” they wrote. “Although our study also demonstrated that the antiviral benefit was primarily seen in [chronic HBV] patients who were younger than age 45 years, female, and of Asian ethnicity, these observations need to be further evaluated in studies with longer follow-up.”

StephenW

乙肝病毒抗病毒治疗可降低肝硬化风险
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根据研究结果，接受抗病毒治疗的慢性乙型肝炎患者的肝硬化风险显着降低。

“很少有研究专门针对非亚洲和非肝硬化人群的HBV抗病毒治疗的益处，尤其是与评估治疗对发展为肝硬化和死亡的风险的影响有关时，”退伍军人医学博士Robert J. Wong，医学博士事务Palo Alto医疗保健系统及其同事写道。 “此外，针对安全网和弱势群体的研究还很有限，因为鉴于及时获得HBV疗法的现有差异以及晚期肝病负担的不成比例，在人群中，了解治疗的益处尤为重要。”

研究人员分析了从2010年至2018年来自四个安全网络卫生系统的4,064例慢性HBV患者的数据。他们评估了HBV治疗对肝硬化，肝细胞癌，死亡以及肝硬化，HCC或死亡的综合风险的影响。

在该患者队列中，女性占51％以上，年龄小于45岁的女性占42％，黑人占31.6％，亚裔占26.7％，西班牙裔占26.7％。此外，23.2％的患者接受了HBV抗病毒治疗，而76.8％的患者没有接受。

在一项倾向评分匹配队列中，包括428名接受治疗的患者和428名未接受治疗的患者，慢性HBV的治疗与较低的肝硬化风险（HR = 0.67; 95％CI，0.46-0.92）和复合性肝硬化，HCC或死亡（HR = 0.67; 95％CI，0.49-0.94）。研究人员发现，女性的风险低于男性，而黑人患者的风险低于非西班牙裔白人。

在按年龄，性别和种族对患者进行分层之后，Wong及其同事发现，年龄小于45岁的亚洲女性从抗病毒治疗中受益最大。

他们写道：“我们对四个城市安全网卫生系统中非肝硬化CHB患者的倾向得分匹配分析表明，由于主要由事件性肝硬化风险降低引起的HBV抗病毒治疗，与肝有关的结局风险显着降低，” 。 “尽管我们的研究还表明，抗病毒药物的获益主要出现在[慢性HBV]患者中，这些患者年龄小于45岁，女性和亚裔，但是这些观察结果需要在随访时间更长的研究中进行进一步评估。”