结构方程模型预测慢性乙型肝炎肝细胞癌的预测因素：一项

StephenW

Predictive Factors for Hepatocellular Carcinoma in Chronic Hepatitis B Using Structural Equation Modeling: A Prospective Cohort Study
Laurent Lam  1 , Hélène Fontaine  2 , Marc Bourliere  3 , Clovis Lusivika-Nzinga  4 , Céline Dorival  4 , Dominique Thabut  5 , Fabien Zoulim  6 , François Habersetzer  7 , Tarik Asselah  8 , Jean-Charles Duclos-Vallee  9 , Jean-Pierre Bronowicki  10 , Philippe Mathurin  11 , Thomas Decaens  12 , Nathalie Ganne  13 , Dominique Guyader  14 , Vincent Leroy  15 , Isabelle Rosa  16 , Victor De Ledinghen  17 , Paul Cales  18 , Xavier Causse  19 , Dominique Larrey  20 , Olivier Chazouilleres  21 , Moana Gelu-Simeon  22 , Véronique Loustaud-Ratti  23 , Sophie Metivier  24 , Laurent Alric  25 , Ghassan Riachi  26 , Jérôme Gournay  27 , Anne Minello  28 , Albert Tran  29 , Claire Geist  30 , Armand Abergel  31 , François Raffi  32 , Louis D'alteroche  33 , Isabelle Portal  34 , Nathanaël Lapidus  1 , Stanislas Pol  35 , Fabrice Carrat  36 , ANRS AFEF Hepather study group
Affiliations

    PMID: 33930591 DOI: 10.1016/j.clinre.2021.101713

Abstract

Background & aims: The factors predicting hepatocellular carcinoma (HCC) occurrence in chronic hepatitis B need to be precisely known to improve its detection. We identified pathways and individual predictive factors associated with HCC in the ANRS CO22 HEPATHER cohort.

Methods: The study analyzed HBV-infected patients recruited at 32 French expert hepatology centers from August 6, 2012, to December 31, 2015. We excluded patients with chronic HCV, HDV and a history of HCC, decompensated cirrhosis or liver transplantation. Structural equation models were developed to characterize the causal pathways leading to HCC occurrence. The association between clinical characteristics (age, gender, body-mass index, liver fibrosis, alcohol consumption, smoking status, diabetes, hypertension, dyslipidemia, alpha-fetoprotein, HBV DNA levels, antiviral therapy) and incident HCC was quantified.

Results: Among the 4,489 patients included, 33 patients reported incident HCC. The median follow-up was 45.2 months. Age (β = 0.18 by decade, 95% CI 0.14-0.23), male gender (β = 0.23, 95% CI 0.18-0.29), metabolic syndrome (β = 0.28, 95% CI 0.22-0.33), alcohol consumption (β = 0.09, 95% CI 0.05-0.14) and HBV DNA (β = 0.25, 95% CI 0.17-0.34) had a significant and direct effect on the occurrence of advanced liver fibrosis. Liver fibrosis (β = 0.71, 95% CI 0.55-0.87) predicted, in turn, the occurrence of HCC.

Conclusions: Liver fibrosis mediates the effects of age, gender, alcohol, metabolic syndrome and HBV DNA on the occurrence of HCC. Elderly men with chronic hepatitis B, risky alcohol use, advanced liver fibrosis, metabolic syndrome and high HBV DNA levels should be monitored closely to detect the development of HCC.

Keywords: Carcinoma; Epidemiology; Hepatitis B virus; Hepatocarcinogenesis; Hepatocellular; Liver Cancer.

Copyright © 2021. Published by Elsevier Masson SAS.

StephenW

结构方程模型预测慢性乙型肝炎肝细胞癌的预测因素：一项前瞻性队列研究
Laurent Lam 1，HélèneFontaine 2，Marc Bourliere 3，Clovis Lusivika-Nzinga 4，CélineDorival 4，Dominique Thabut 5，Fabien Zoulim 6，FrançoisHabersetzer 7，Tarik Asselah 8，Jean-Charles Duclos-Vallee 9，Jean-Pierre Bronowicki 10，菲利普·马图林（Philippe Mathurin）11，托马斯·迪卡恩斯（Thomas Decaens）12，纳塔莉·甘妮（Nathalie Ganne）13，多米尼克·盖亚德（Dominique Guyader）14，文森特·勒洛伊（Vincent Leroy）15，伊莎贝拉·罗莎（Isabelle Rosa）16，维克托·德·莱丁亨（Victor De Ledinghen）17，保罗·卡尔斯（Paul Cales）18，泽维尔·高斯（Xavier Causse）19，多米尼克·拉里（Dominique Larrey）20，奥利维尔·查祖列斯（Olivier Chazouilleres）21，莫阿纳·盖卢鲁（Moana Gelu-lu） Simeon 22，VéroniqueLoustaud-Ratti 23，Sophie Metivier 24，Laurent Alric 25，Ghassan Riachi 26，JérômeGournay 27，Anne Minello 28，Albert Tran 29，Claire Geist 30，Armand Abergel 31，FrançoisRaffi 32，Louis D'alteroche 33 ，Isabelle Portal 34，NathanaëlLapidus 1，Stanislas Pol 35，Fabrice Carrat 36，ANRS AFEF Hepather研究小组
隶属关系

    PMID：33930591 DOI：10.1016 / j.clinre.2021.101713

抽象的

背景与目的：需要准确知道预测慢性乙型肝炎发生肝细胞癌（HCC）的因素，以提高其检测率。我们在ANRS CO22 HEPATHER队列中确定了与HCC相关的途径和个体预测因素。

方法：该研究分析了2012年8月6日至2015年12月31日在32个法国专家肝病学中心招募的HBV感染患者。我们排除了具有慢性HCV，HDV和HCC史，失代偿性肝硬化或肝移植的患者。开发了结构方程模型以表征导致HCC发生的因果途径。量化了临床特征（年龄，性别，体重指数，肝纤维化，饮酒，吸烟状况，糖尿病，高血压，血脂异常，甲胎蛋白，HBV DNA水平，抗病毒治疗）与HCC事件之间的关联。

结果：在包括4489例患者中，有33例报告了HCC事件。中位随访时间为45.2个月。年龄（β= 0.18，十年，95％CI 0.14-0.23），男性（β= 0.23，95％CI 0.18-0.29），代谢综合症（β= 0.28，95％CI 0.22-0.33），饮酒（β = 0.09，95％CI 0.05-0.14）和HBV DNA（β= 0.25，95％CI 0.17-0.34）对晚期肝纤维化的发生有直接的显着影响。肝纤维化（β= 0.71，95％CI 0.55-0.87）反过来预示着肝癌的发生。

结论：肝纤维化介导年龄，性别，酒精，代谢综合征和HBV DNA对肝癌发生的影响。应密切监测患有慢性乙型肝炎，高危饮酒，晚期肝纤维化，代谢综合征和高HBV DNA水平的男性，以检测HCC的发展。

关键字：癌；流行病学；乙型肝炎病毒;肝癌发生；肝细胞肝癌。

版权所有©2021.由Elsevier Masson SAS发布。