HBV 基因型是决定哪些慢性 HBV 患者应接受 HCC 监测的重要因素

StephenW

HBV 基因型是决定哪些慢性 HBV 患者应接受 HCC 监测的重要因素

肝病学（马里兰州巴尔的摩）

带回家的消息

    这项研究调查了阿拉斯加流行地区 1185 名患有慢性乙肝病毒的阿拉斯加本地人。自 1983 年以来，在一项长期研究中对这些人进行了随访，中位随访时间为 35.1 年。本研究特别关注 HBV 基因型及其对 HCC 发展的影响。在发现的五种 HBV 基因型（A2、B6、C2、D 和 F1）中，基因型分布为 49% D、18% F、13% A、6% C、3% B、0.1% H 和 12%未定。随访期间共发生HCC 63例，F1基因型（5.73/1000人年）发生率最高，相对危险度（RR）为12.7，其次为C2、A2、D和然后是 B6（每 1,000 人年 0.0）。

    HBV 基因型与 HCC 有很强的相关性，应考虑到风险分层。它应该是筛查算法和 HCC 监测建议的一部分。

– 娜塔莎·冯·罗恩，医学博士
抽象的

该摘要可在出版商的网站上找到。
背景和目标

关于 HBV 基因型和慢性 HBV (CHB) 感染结果的信息有限。我们检查了 HBV 基因型对阿拉斯加原住民 (AN) CHB 患者 HCC 发生的影响，其中发现了五种 HBV 基因型：A2、B6、C2、D 和 F1。
方法和结果

我们计算了每 1,000 人年随访的 HCC 发病率，以确定哪些年龄、性别和基因型组符合当前美国肝病研究协会 (AASLD) 的 HCC 监测标准。我们使用泊松回归来比较基因型、年龄、性别和阿拉斯加地区的 HCC 风险。 HCC 的发病率是使用为亚洲人群推荐的性别特异性 AASLD 临界值计算的，女性为 50 岁，男性为 40 岁。使用甲胎蛋白水平和腹部超声每半年进行一次 HCC 筛查。在 1,185 名 AN 患者中，中位随访时间为 35.1 年； 667 (63%) 名男性。 HBV 基因型分布为 49% D、18% F、13% A、6% C、3% B、0.1% H 和 12% 未确定。发生了 63 例 HCC。基因型 F 的 HCC 发生率为每 1,000 人年随访 5.73，其次是 C 4.77、A 1.28、D 0.47 和 B 0.00。基因型 F 的 HCC 风险更高（相对率 [RR] , 12.7; 95% CI, 6.1-26.4), C (RR, 10.6; 95% CI, 4.3-26.0), and A (RR, 2.9; 95% CI, 1.0-8.0) 与基因型 B 和 D 相比。男性 < 40 岁和女性 < 50 岁，基因型 F 的发病率最高（4.79/1,000 人年）。
结论

HBV 基因型与 HCC 密切相关。在危险因素分层中应考虑 HBV 基因型。

StephenW

HBV Genotype Is a Significant Factor in Determining Which Chronic HBV Patients Should Undergo Surveillance for HCC

Hepatology (Baltimore, Md.)

TAKE-HOME MESSAGE

    This study looks at 1185 Alaska natives with chronic hepatitis HBV in an area of Alaska where it is endemic. These individuals have been followed in a long-term study since 1983, with a median follow up of 35.1 years. This study specifically looks at the HBV genotype and its effect on the development of HCC. Of the five HBV genotypes found (A2, B6, C2, D, and F1), the genotype distribution was 49% D, 18% F, 13% A, 6% C, 3% B, 0.1% H, and 12% undetermined. There have been 63 cases of HCC occurring in the follow-up period, with the genotype F1 (5.73 per 1,000 person-years) having the greatest occurrence with a relative risk (RR) of 12.7, followed by C2, A2, D, and then B6 (0.0 per 1,000 person-years).

    HBV genotype has a strong association with HCC, and should be taken into account for risk stratification. It should be part of screening algorithms and HCC surveillance recommendations.

–  Natasha von Roenn, MD
abstract

This abstract is available on the publisher's site.
BACKGROUND AND AIMS

Information is limited regarding HBV genotype and the outcome of chronic HBV (CHB) infection. We examined the effect of HBV genotype on HCC occurrence in Alaska Native (AN) persons with CHB, where five HBV genotypes are found: A2, B6, C2, D, and F1.
APPROACH AND RESULTS

We calculated HCC incidence per 1,000 person-years of follow-up to determine which groups by age, sex, and genotype met current American Association for the Study of Liver Diseases (AASLD) HCC surveillance criteria. We used Poisson regression to compare HCC risk by genotype, age, sex, and Alaska region. Incidence of HCC was calculated using the sex-specific AASLD cutoff recommended for the Asian population of 50 years for women and 40 years for men. HCC screening was conducted semiannually using alpha-fetoprotein levels and abdominal ultrasound. Among 1,185 AN persons, median follow-up was 35.1 years; 667 (63%) were male. The HBV genotype distribution was 49% D, 18% F, 13% A, 6% C, 3% B, 0.1% H, and 12% undetermined. Sixty-three cases of HCC occurred. HCC incidence for genotype F was 5.73 per 1,000 person-years of follow-up, followed by 4.77 for C, 1.28 for A, 0.47 for D, and 0.00 for B. The HCC risk was higher for genotypes F (relative rate [RR], 12.7; 95% CI, 6.1-26.4), C (RR, 10.6; 95% CI, 4.3-26.0), and A (RR, 2.9; 95% CI, 1.0-8.0) compared to genotypes B and D. Among men < 40 years of age and women < 50 years of age, genotype F had the highest incidence (4.79/1,000 person-years).
CONCLUSIONS

HBV genotype was strongly associated with HCC. HBV genotype should be considered in risk factor stratification.