修订后的韩国抗病毒指南降低了肝硬化患者乙型肝炎相关的

StephenW

Revised Korean Antiviral Guideline Reduces the Hepatitis B-related Hepatocellular Carcinoma Risk in Cirrhotic Patients
David Sooik Kim #  1 , Soo Young Park #  2 , Beom Kyung Kim  1   3 , Jun Yong Park  1   3 , Do Young Kim  1   3 , Kwang Hyub Han  1   3 , Yu Rim Lee  2 , Won Young Tak  2 , Young Oh Kweon  2 , Inkyung Jung  4 , Minkyung Han  5 , Eun Hwa Kim  5 , Sang Hoon Ahn  1   3 , Seung Up Kim  1   6
Affiliations

    PMID: 33904261 DOI: 10.3346/jkms.2021.36.e105

Abstract

Background: Since September 2015, the initiation of antiviral therapy (AVT) for patients with chronic hepatitis B (CHB)-related cirrhosis has been reimbursed according to the revised Korean Association for the Study of Liver (KASL) guideline, if the patient had hepatitis B virus DNA level ≥ 2,000 IU/L, regardless of aminotransferase or alanine aminotransferase levels. This study investigated whether the KASL guideline implementation reduced the risk of CHB-related hepatocellular carcinoma (HCC) in patients with cirrhosis in South Korea.

Methods: A total of 429 patients with CHB-related cirrhosis who initiated AVT between 2014 and 2016 were recruited. The risk of HCC development was compared between patients who initiated AVT before and after September 2015 (pre-guideline [n = 196, 45.7%] vs. post-guideline implementation [n = 233, 54.3%]).

Results: Univariate analysis showed that AVT initiation before guideline implementation, older age, male gender, and diabetes significantly predicted increased risk of HCC development (all P < 0.05). Subsequent multivariate analysis showed that AVT initiation before guideline implementation (HR = 1.941), older age (HR = 5.762), male gender (HR = 2.555), and diabetes (HR = 1.568) independently predicted increased risk of HCC development (all P < 0.05). Additionally, multivariate analysis showed that AVT initiation before guideline implementation (HR = 2.309), male gender (HR = 3.058), and lower platelet count (HR = 0.989) independently predicted mortality (P < 0.05). The cumulative incidences of HCC and mortality were significantly higher in patients who initiated AVT before guideline implementation than in those who initiated AVT after guideline implementation (all P < 0.05, log-rank test).

Conclusion: The prognosis of patients with CHB-related cirrhosis who initiated AVT improved after guideline implementation according to the revised KASL guideline.

Keywords: Antiviral Therapy; Guideline; Hepatitis B; Hepatocellular Carcinoma; Management.

© 2021 The Korean Academy of Medical Sciences.

StephenW

修订后的韩国抗病毒指南降低了肝硬化患者乙型肝炎相关的肝细胞癌的风险
David Sooik Kim 1，Soo Young Park 2，Beom Kyung Kim 1 3，Jun Yong Park 1 3，Do Young Kim 1 3，Kwang Hyub Han 1 3，Yur Rim Lee 2，Won Young Tak 2，Young Oh Kweon 2 ，Inkyung Jung 4，Minkyung Han 5，Eun Hwa Kim 5，Sang Hoon Ahn 1 3，Seung Up Kim 1 6
隶属关系

    PMID：33904261 DOI：10.3346 / jkms.2021.36.e105

抽象的

背景：自2015年9月起，根据修订后的韩国肝病研究协会（KASL）指南，如果慢性乙型肝炎（CHB）相关性肝硬化患者已开始抗病毒治疗（AVT），如果该患者患有肝炎，该费用已报销无论氨基转移酶或丙氨酸氨基转移酶水平如何，乙型病毒DNA≥2,000 IU / L。这项研究调查了KASL指南的实施是否降低了韩国肝硬化患者CHB相关性肝细胞癌（HCC）的风险。

方法：总共招募了429例2014年至2016年间发起AVT的CHB相关性肝硬化患者。在2015年9月之前和之后发起AVT的患者之间比较了发生HCC的风险（指南前[n = 196，45.7％]与指南后实施[n = 233，54.3％]）。

结果：单因素分析表明，在实施指南，年龄，男性，糖尿病和糖尿病之前开始AVT显着预测了HCC发生的风险增加（所有P <0.05）。随后的多变量分析显示，在实施指南之前（AHR = 1.941），年龄较大（HR = 5.762），男性（HR = 2.555）和糖尿病（HR = 1.568）进行AVT的独立预测会增加HCC发生的风险（所有P < 0.05）。此外，多变量分析显示，在指南实施前开始AVT（HR = 2.309），男性（HR = 3.058）和较低的血小板计数（HR = 0.989）可以独立预测死亡率（P <0.05）。指南实施前开始AVT的患者的HCC累积发生率和死亡率显着高于指南实施后开始AVT的患者（所有P <0.05，对数秩检验）。

结论：根据修订的KASL指南，实施指南后，开始AVT的CHB相关性肝硬化患者的预后得到改善。

关键字：抗病毒治疗；准则；乙型肝炎；肝细胞癌；管理。

©2021韩国医学科学院。

StephenW

https://jkms.org/DOIx.php?id=10.3346/jkms.2021.36.e105