慢性乙型肝炎年轻成人的肝纤维化评分和肝脏相关死亡风险

StephenW

慢性乙型肝炎年轻成人的肝纤维化评分和肝脏相关死亡风险：一项队列研究
Won Sohn 1 , Yoosoo Chang 2 3 4 , Yong Kyun Cho 1 4 , Yun Soo Hong 5 , Hocheol Shin 2 6 , Seungho Ryu 2 3 4
隶属关系
隶属关系

    1
    韩国首尔成均馆大学医学院江北三星医院内科消化内科和肝脏科。
    2
    韩国首尔成均馆大学江北三星医院综合保健中心队列研究中心。
    3
    韩国首尔成均馆大学医学院江北三星医院职业与环境医学系。
    4
    韩国首尔成均馆大学 SAIHST 临床研究设计与评估系。
    5
    美国马里兰州巴尔的摩约翰霍普金斯大学布隆伯格公共卫生学院流行病学和韦尔奇预防、流行病学和临床研究中心。
    6
    韩国首尔成均馆大学医学院江北三星医院家庭医学科。

    PMID：34582599 DOI：10.1111/jvh.13618

抽象的

无创肝纤维化评分对 40 岁以下慢性乙型肝炎患者肝脏相关死亡率的预测作用仍未阐明。我们研究了乙型肝炎病毒 (HBV) 感染的年轻人（<40 岁）和老年人肝纤维化评分与肝脏相关死亡率的关联。一项队列研究对 21,360 名基线时没有肝硬化或肝癌的 HBsAg 阳性韩国成年人进行了长达 18 年的随访。使用纤维化 4 评分 (FIB-4) 和天冬氨酸转氨酶与血小板比率指数 (APRI) 确定肝纤维化评分。通过国家死亡记录确定患者的生命状态和死因。在中位随访 10.2 年期间，确定了 283 例肝脏相关死亡（肝脏相关死亡率，127.4/105 人年）。肝纤维化评分与肝脏相关死亡风险的增加显着相关；这种关联在年龄组中没有差异（<40 岁 vs. ≥40 岁）。与中、高到低 FIB-4 评分相比，肝脏相关死亡率的多变量调整 HR 为 95% CI，在 40 岁以下个体中分别为 4.23 (1.99-9.00) 和 15.16 (5.18-44.38)，以及 4.46 ( 3.03-6.56) 和 22.47 (15.11-33.41)，分别在老年人中。这些关联在使用 APRI 的分析中是相似的。在这组 HBsAg 阳性个体中，肝纤维化评分与年轻人和老年人的肝脏相关死亡风险增加有关。肝纤维化评分可用于预测肝脏死亡率，即使在患有 HBV 的年轻人中也是如此。

关键词：队列研究；乙型肝炎病毒;肝癌;死亡;无创纤维化评分。

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StephenW

Liver fibrosis scores and risk of liver-related mortality in young adults with chronic hepatitis B: A cohort study
Won Sohn  1 , Yoosoo Chang  2   3   4 , Yong Kyun Cho  1   4 , Yun Soo Hong  5 , Hocheol Shin  2   6 , Seungho Ryu  2   3   4
Affiliations
Affiliations

    1
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
    2
    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea.
    3
    Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea.
    4
    Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
    5
    Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
    6
    Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.

    PMID: 34582599 DOI: 10.1111/jvh.13618

Abstract

The predictive role of noninvasive liver fibrosis scores on liver-related mortality in patients with chronic hepatitis B below 40 years of age remains unclarified. We examined the association of liver fibrosis scores with liver-related mortality in young (<40 years) and older adults with hepatitis B virus (HBV) infection. A cohort study was performed in 21,360 HBsAg-positive Korean adults without liver cirrhosis or liver cancer at baseline who were followed up for up to 18 years. The liver fibrosis scores were determined using the fibrosis-4 score (FIB-4) and aspartate transaminase to platelet ratio index (APRI). Patients' vital status and cause of death were ascertained through the National Death Records.During a median follow-up of 10.2 years, 283 liver-related deaths were identified (liver-related mortality, 127.4/105 person-years). The liver fibrosis scores were significantly associated with increased risks of liver-related mortality; this association did not differ by age group (<40 vs. ≥40 years). The multivariable-adjusted HRs with 95% CIs for liver-related mortality comparing intermediate and high to low FIB-4 scores were 4.23 (1.99-9.00), and 15.16 (5.18-44.38), respectively, among individuals under 40, and 4.46 (3.03-6.56) and 22.47 (15.11-33.41), respectively, among older individuals. These associations were similar in analyses using APRI. In this cohort of HBsAg-positive individuals, the liver fibrosis scores were associated with increased risks of liver-related mortality in young and older adults. The liver fibrosis scores have a role in predicting liver mortality, even in young adults with HBV.

Keywords: cohort study; hepatitis B virus; liver cancer; mortality; noninvasive fibrosis score.

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gongxisheng

国内都在等肝硬化在评估，国外已经提前到肝纤前了。看来越早抗病毒越重要