乙型肝炎病毒相關失代償期肝硬化患者開始抗病毒治療後再

StephenW

乙型肝炎病毒相關失代償期肝硬化患者開始抗病毒治療後再代償的決定因素
Tae Hyung Kim 1 , Soon Ho Um 1 , Young-Sun Lee 1 , Sun Young Yim 1 , Young Kul Jung 1 , Yeon Seok Seo 1 , Ji Hoon Kim 1 , Hyunggin An 2 , Hyung Joon Yim 1 , Jong Eun Yeon 1 ,關秀彬 1
隸屬關係
隸屬關係

    1
    韓國首爾高麗大學醫學院內科系。
    2
    韓國首爾高麗大學醫學院生物統計學系。

    PMID：34662436 DOI：10.1111/apt.16658

抽象的

背景：儘管進行了抗病毒治療，但乙型肝炎病毒 (HBV) 相關的失代償性肝硬化患者的肝功能往往無法恢復。

目的：建立預後模型以預測開始有效核苷（酸）類似物（NUC）治療的患者的再補償方法：我們分析了 311 名接受恩替卡韋或替諾福韋治療的 HBV 相關失代償性肝硬化患者。主要結果是再補償，定義為 Child-Pugh 評分恢復到 5 分。BC2AID 評分是根據競爭風險模型從 152 名受試者的隊列中得出的，並在另一個 159 名受試者的隊列中得到驗證。

結果：在推導和驗證隊列中，分別有 57.2% 和 66.7% 的受試者發生了再補償。在推導隊列中確定了重新補償的六個獨立預測因子，其中包括 BC2AID 評分：膽紅素≤5 mg/dL（調整後的亞分佈風險比 [aSHR] 2.18）、沒有嚴重並發症（aSHR 2.78）、α-胎蛋白 (AFP) ≥50 ng/mL (aSHR 2.54)，丙氨酸轉氨酶 ≥200 IU/L (aSHR 2.62)，國際標準化比率 ≤1.5 (aSHR 2.37) 且從初始失代償到開始 NUC 的時間≤6 個月 (aSHR 4.7) .在驗證隊列中，用於 NUC 治療 1 年內再補償的 BC2AID 評分的受試者操作特徵曲線下面積顯著高於 Child-Pugh、MELD、MELDNa 和 BE3A 評分（0.813 vs 0.691、0.638 ，分別為 0.645 和 0.624；所有 P < 0.05)。

結論：將包括 AFP 和抗病毒治療時間在內的 6 個臨床參數組合成一個評分系統，以準確預測 HBV 相關失代償期肝硬化患者的早期再補償。

© 2021 約翰威利父子公司。

StephenW

Determinants of re-compensation in patients with hepatitis B virus-related decompensated cirrhosis starting antiviral therapy
Tae Hyung Kim  1 , Soon Ho Um  1 , Young-Sun Lee  1 , Sun Young Yim  1 , Young Kul Jung  1 , Yeon Seok Seo  1 , Ji Hoon Kim  1 , Hyunggin An  2 , Hyung Joon Yim  1 , Jong Eun Yeon  1 , Kwan Soo Byun  1
Affiliations
Affiliations

    1
    Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
    2
    Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.

    PMID: 34662436 DOI: 10.1111/apt.16658

Abstract

Background: Despite antiviral therapy, liver function often fails to recover in patients with hepatitis B virus (HBV)-related decompensated cirrhosis.

Aim: To establish a prognostic model to predict re-compensation in patients starting potent nucleos(t)ide analogue (NUC) therapy METHODS: We analysed 311 consecutive patients with HBV-related decompensated cirrhosis treated with entecavir or tenofovir. The primary outcome was re-compensation, defined as recovery to a Child-Pugh score of 5. The BC2AID score was developed from a cohort of 152 subjects based on competing risk models and validated in another cohort of 159 subjects.

Results: Re-compensation occurred in 57.2% and 66.7% of the subjects in the derivation and validation cohorts, respectively. Six independent predictors for re-compensation were identified in the derivation cohort and these comprised the BC2AID score: bilirubin ≤5 mg/dL (adjusted sub-distribution hazard ratio [aSHR] 2.18), absence of severe complications (aSHR 2.78), alpha-fetoprotein (AFP) ≥50 ng/mL (aSHR 2.54), alanine aminotransferase ≥200 IU/L (aSHR 2.62), international normalised ratio ≤1.5 (aSHR 2.37) and ≤6 months from initial decompensation until initiation of NUCs (aSHR 4.79). In the validation cohort, the area under the receiver operating characteristic curve of the BC2AID score for re-compensation within 1 year of NUC therapy was significantly higher than that of the Child-Pugh, MELD, MELDNa and BE3A scores (0.813 vs 0.691, 0.638, 0.645 and 0.624, respectively; all P < 0.05).

Conclusions: Six clinical parameters, including AFP and the timing of antiviral therapy, were combined into a scoring system to accurately predict early re-compensation in patients with HBV-related decompensated cirrhosis.

© 2021 John Wiley & Sons Ltd.