核苷（酸）类似物治疗慢性乙型肝炎患者血清乙型肝炎病毒RN

StephenW

核苷（酸）类似物治疗慢性乙型肝炎患者血清乙型肝炎病毒RNA与肝细胞癌风险的相关性
石流1、邓瑞1、周斌1、谢尔梁1、刘志宏1、杰鹏1、陈金军1、周元平1、亚兵郭1、陈永鹏1、万英利1、申神1、星宇路1、赵思如1、廖星美1、红艳梁1、玉兰1、金林侯1、荣凡1、孙建1
隶属关系
联系

    1
    南方医科大学南方医院感染科，广东省病毒性肝炎研究重点实验室，器官衰竭研究国家重点实验室，广州，510515。

    PMID：34931674 DOI：10.1093/infdis/jiab597

抽象的

背景：血清乙型肝炎病毒 (HBV) RNA 是否与慢性乙型肝炎 (CHB) 患者的肝细胞癌 (HCC) 发展相关尚未完全阐明。

方法：我们从前瞻性、观察性 CHB 队列中招募了 2974 名接受核苷（酸）类似物 (NAs) 的患者，以使用 Cox 回归分析研究在研究开始时（基线）测量的血清 HBV RNA 对 HCC 发展的影响。

结果：在 4.4 年的中位随访期间，90 名患者发展为 HCC。基线 HBV RNA 可检测到的患者 (n=2072) 的 HCC 风险显着高于未检测到的患者（通过 Kaplan-Meier 方法估计的 5 年 HCC 发病率：4.1% vs 1.8%，P=0.007；调整后的风险比 [aHR] =2.21，P=0.005）。与检测不到的水平（<609 拷贝/ml）相比，609-99,999 和 ≥100,000 拷贝/ml 的 HBV RNA 水平与逐渐增加的 HCC 风险相关（aHR 分别为 2.15 和 3.05；趋势 P=0.003）。此外，与双重检测不到 DNA 和 RNA 的患者相比，具有单一检测到 HBV DNA 或 RNA 以及双重检测到 DNA 和 RNA 的患者的 HCC 风险分别高出 1.57 和 4.02 倍（趋势 P=0.001）。

结论：高水平 HBV RNA 与 NAs 治疗患者的 HCC 风险增加相关。实现不可检测的 HBV RNA 可能有助于更好的临床结果，表明它可能是抗 HBV 治疗的一个有价值的终点。

关键词：乙肝病毒RNA；肝癌;核苷（酸）类似物；风险因素。

© The Author(s) 2021。牛津大学出版社为美国传染病学会出版。版权所有。如需权限，请发送电子邮件至：[email protected]。

StephenW

Association of serum hepatitis B virus RNA with hepatocellular carcinoma risk in chronic hepatitis B patients under nucleos(t)ide analogues therapy
Shi Liu  1 , Rui Deng  1 , Bin Zhou  1 , Xieer Liang  1 , Zhihong Liu  1 , Jie Peng  1 , Jinjun Chen  1 , Yuanping Zhou  1 , Yabing Guo  1 , Yongpeng Chen  1 , Wanying Li  1 , Sheng Shen  1 , Xingyu Lu  1 , Siru Zhao  1 , Xingmei Liao  1 , Hongyan Liang  1 , Yu Lan  1 , Jinlin Hou  1 , Rong Fan  1 , Jian Sun  1
Affiliations
Affiliation

    1
    State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.

    PMID: 34931674 DOI: 10.1093/infdis/jiab597

Abstract

Background: Whether serum hepatitis B virus (HBV) RNA associates with hepatocellular carcinoma (HCC) development in chronic hepatitis B (CHB) patients has not been fully elucidated.

Methods: We enrolled 2974 patients receiving nucleos(t)ide analogues (NAs) from a prospective, observational CHB cohort to investigate the effect of serum HBV RNA, measured at study entry (baseline), on HCC development, using Cox regression analyses.

Results: During median follow-up of 4.4 years, 90 patients developed HCC. Patients with detectable baseline HBV RNA (n=2072) exhibited significantly higher HCC risk than those with undetectable level (5-year HCC incidence estimated by Kaplan-Meier method: 4.1% versus 1.8%, P=0.007; adjusted hazard ratio [aHR]=2.21, P=0.005). HBV RNA levels of 609-99,999 and ≥100,000 copies/ml were associated with incrementally increasing HCC risk (aHR=2.15 and 3.05, respectively; P for trend=0.003), compared to undetectable level (<609 copies/ml). Moreover, patients with single-detectable either HBV DNA or RNA and double-detectable DNA and RNA had 1.57- and 4.02-fold higher HCC risk respectively, than those with double undetectable DNA and RNA (P for trend=0.001).

Conclusion: High-level HBV RNA is associated with increased HCC risk in NAs-treated patients. Achieving undetectable HBV RNA may contribute to better clinical outcomes, indicating it could be a valuable endpoint of anti-HBV treatment.

Keywords: Hepatitis B virus RNA; liver cancer; nucleos(t)ide analogues; risk factor.

© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].