未经抗病毒治疗的乙型肝炎病毒患者肝细胞癌累积发生率的

StephenW

Long-term follow-up of cumulative incidence of hepatocellular carcinoma in hepatitis B virus patients without antiviral therapy
Xiao-Yan Jiang  1 , Bing Huang  1 , Dan-Ping Huang  2 , Chun-Shan Wei  2 , Wei-Chao Zhong  2 , De-Ti Peng  2 , Fu-Rong Huang  2 , Guang-Dong Tong  3
Affiliations
Affiliations

    1
    Department of Gastroenterology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, Guangdong Province, China.
    2
    Department of Hepatology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, Guangdong Province, China.
    3
    Department of Hepatology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, Guangdong Province, China. [email protected].

    PMID: 33776376 PMCID: PMC7985729 DOI: 10.3748/wjg.v27.i11.1101

Free PMC article
Abstract

Background: China has a high prevalence of hepatitis B virus (HBV), but most chronic hepatitis B (CHB) patients do not receive standardized antiviral therapy. There are few relevant reports addressing the outcomes of the large number of CHB patients who do not receive antiviral therapy.

Aim: To observe the outcomes of long-term follow-up of patients with CHB without antiviral treatment.

Methods: This study included 362 patients with CHB and 96 with hepatitis B cirrhosis without antiviral treatment and with only liver protection and anti-inflammatory treatment from 1993 to 1998. The median follow-up times were 10 and 7 years, respectively. A total of 203 CHB and 129 hepatitis B cirrhosis patients receiving antiviral therapy were selected as the control groups. The median follow-up times were 8 and 7 years, respectively. Kaplan-Meier curves were used to analyze the cumulative incidence of hepatocellular carcinoma (HCC), and the Cox regression model was used to analyze the risk factors for HCC.

Results: Among the patients in the non-antiviral group, 16.9% had spontaneous decreases in HBV DNA to undetectable levels, and 32.8% showed hepatitis B e antigen (HBeAg) seroconversion. In the antiviral group, 87.2% of patients had undetectable HBV DNA, and 52% showed HBeAg seroconversion. Among CHB and hepatitis B cirrhosis patients, the cumulative incidence rates of HCC were 14.9% and 53.1%, respectively, in the non-antiviral group and were 10.7% and 31.9%, respectively, in the antiviral group. There was no difference between the two groups regarding the CHB patients (P = 0.842), but there was a difference between the groups regarding the hepatitis B cirrhosis patients (P = 0.026). The cumulative incidence rates of HCC were 1.6% and 22.3% (P = 0.022) in the groups with and without spontaneous HBeAg seroconversion, respectively. The incidence rates of HCC among patients with and without spontaneous declines in HBV DNA to undetectable levels were 1.6% and 19.1%, respectively (P = 0.051). There was no difference in the cumulative incidence of HCC between the two groups regarding the patients with drug-resistant CHB (P = 0.119), but there was a significant difference between the two groups regarding the patients with cirrhosis (P = 0.004). The Cox regression model was used for regression of the corrected REACH-B score, which showed that alanine aminotransferase > 400 U/L, history of diabetes, and family history of liver cancer were risk factors for HCC among men aged > 40 years (P < 0.05). Multifactorial analysis showed that a family history of HCC among men was a risk factor for HCC.

Conclusion: Antiviral therapy and non-antiviral therapy with liver protection and anti-inflammatory therapy can reduce the risk of HCC. Antiviral therapy may mask the spontaneous serological response of some patients during CHB. Therefore, the effect of early antiviral therapy on reducing the incidence of HCC cannot be overestimated.

Keywords: Anti-inflammatory therapy; Antiviral therapy; Chronic hepatitis B; Cumulative incidence; Hepatocellular carcinoma; Hepatoprotective therapy.

©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

StephenW

未经抗病毒治疗的乙型肝炎病毒患者肝细胞癌累积发生率的长期随访
江小燕1，黄冰1，黄丹萍2，魏春山2，钟伟超2，彭德添2，黄富荣2，广东通3
隶属关系
隶属关系

    1个
    广州中医药大学第四临床医学院深圳中医院消化内科，广东深圳518033
    2个
    广州中医药大学第四临床医学院深圳中医医院肝病科，广东深圳518033
    3
    广州中医药大学第四临床医学院深圳中医医院肝科，广东深圳518033 [email protected]。

    PMID：33776376 PMCID：PMC7985729 DOI：10.3748 / wjg.v27.i11.1101

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抽象的

背景：中国的乙型肝炎病毒（HBV）患病率很高，但大多数慢性乙型肝炎（CHB）患者未接受标准化的抗病毒治疗。很少有相关报告涉及大量未接受抗病毒治疗的CHB患者的预后。

目的：观察未经抗病毒治疗的慢性乙型肝炎患者的长期随访结果。

方法：该研究纳入了1993年至1998年间362例CHB患者和96例未经抗病毒治疗且仅接受肝脏保护和抗炎治疗的乙肝肝硬化患者，中位随访时间分别为10年和7年。选择接受抗病毒治疗的203例CHB和129例乙型肝炎肝硬化患者作为对照组。中位随访时间分别为8年和7年。用Kaplan-Meier曲线分析肝细胞癌（HCC）的累积发生率，用Cox回归模型分析肝癌的危险因素。

结果：在非抗病毒组的患者中，HBV DNA的自发性降低至不可检测的水平为16.9％，而乙型肝炎e抗原（HBeAg）血清转化为32.8％。在抗病毒组中，87.2％的患者检测不到HBV DNA，而52％的患者表现出HBeAg血清转化。在CHB和乙型肝炎肝硬化患者中，非抗病毒组的HCC累积发生率分别为14.9％和53.1％，而抗病毒组的HCC累积发生率分别为10.7％和31.9％。两组之间在CHB患者之间没有差异（P = 0.842），但是在乙型肝炎肝硬化患者之间两组之间没有差异（P = 0.026）。有和没有自发性HBeAg血清转化的组中，肝癌的累积发生率分别为1.6％和22.3％（P = 0.022）。有和没有HBV DNA自发性下降至无法检测水平的患者中HCC的发生率分别为1.6％和19.1％（P = 0.051）。耐药性CHB患者两组的HCC累积发生率无差异（P = 0.119），而肝硬化患者两组之间的HCC累积发生率有显着差异（P = 0.004）。使用Cox回归模型对校正后的REACH-B评分进行回归，结果表明，丙氨酸转氨酶> 400 U / L，糖尿病史和肝癌家族史是40岁以上男性HCC的危险因素（P <0.05）。多因素分析表明，男性肝癌家族史是肝癌的危险因素。

结论：抗病毒治疗和非抗病毒治疗结合肝脏保护和抗炎治疗可以降低肝癌的风险。抗病毒治疗可能掩盖了部分患者在慢性乙型肝炎期间的自发血清反应。因此，不能高估早期抗病毒治疗对降低HCC发生率的作用。

关键词：抗炎治疗；抗病毒治疗；慢性乙型肝炎；累积发生率；肝细胞癌；保肝治疗。

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StephenW

https://www.wjgnet.com/1007-9327/full/v27/i11/1101.htm