不同年龄、性别、治疗和疾病活动的慢性乙型肝炎进展率

StephenW

不同年龄、性别、治疗和疾病活动的慢性乙型肝炎进展率

临床胃肠病学和肝病学

带回家的信息

    本研究确定了 18,338 名慢性乙型肝炎 (CHB) 患者的肝硬化和肝细胞癌 (HCC) 发病率，这些患者按年龄、性别、疾病活动和治疗状态等各种参数进行分层。 HCC 发病率因人群而异。根据 AASLD 标准，肝硬化发展的年发病率范围为 0.07% 至 3.94%。 HCC 发展的变异性甚至更大，无肝硬化患者的发病率范围为 0.04% 至 2.19%，肝硬化患者的发病率范围为 0.4% 至 8.83%。

    未来关于 CHB 模型的研究和对 HCC 监测的建议应基于精确的疾病进展率。

– Natasha von Roenn，医学博士
抽象的

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背景与目标

抗病毒治疗标准基于疾病进展风险，对无肝硬化的慢性乙型肝炎 (CHB) 患者的肝细胞癌 (HCC) 监测建议基于 0.2% 的年发病率阈值。然而，准确和精确的疾病进展估计数据是有限的。因此，我们旨在根据 2018 年美国肝病研究协会和 2017 年欧洲肝病研究协会指南，确定按年龄、性别、治疗状态和疾病活动分层的肝硬化和 HCC 发展率。
方法

我们分析了来自美国 6 个中心和亚太国家 27 个中心的 18,338 名患者（8914 名接受治疗，9424 名未接受治疗）。 Kaplan-Meier 方法用于估计以人年为单位的肝硬化或 HCC 年进展率。
结果

该队列为 63% 的男性，平均年龄为 46.19 岁，基线肝硬化率为 14.3%，中位随访时间为 9.60 年。根据美国肝病研究协会的标准，根据年龄、性别和疾病活动性，肝硬化的年发病率范围为 0.07% 至 3.94%，无肝硬化患者的 HCC 年发病率为 0.04% 至 2.19%，以及 0.40肝硬化患者的 HCC 发病率 % 至 8.83%。几个没有肝硬化的患者亚组，包括 40 岁以下的男性和 50 岁以下的女性，每年的 HCC 风险接近或超过 0.2%。使用欧洲肝脏研究协会标准发现了类似的结果。
结论

即使在“低风险”人群中，慢性乙型肝炎疾病进展率也存在很大差异。未来的 CHB 模型研究、公共卫生计划和 HCC 监测建议应基于基于性别、年龄和疾病活动以及治疗状态的更精确的疾病进展率。

StephenW

Chronic Hepatitis B Progression Rates by Age, Sex, Treatment, and Disease Activity

Clinical Gastroenterology and Hepatology

TAKE-HOME MESSAGE

    This study determined the rates of cirrhosis and hepatocellular carcinoma (HCC) in 18,338 patients with chronic hepatitis B (CHB) stratified by various parameters such as age, sex, disease activity, and treatment status. The rates of HCC incidence varied across populations. Based on the AASLD criteria, the annual incidence rates of cirrhosis development ranged from 0.07% to 3.94%. The variability was even greater for HCC development, with incidence rates ranging from 0.04% to 2.19% in patients without cirrhosis and from 0.4% to 8.83% in patients with cirrhosis.

    Future studies on CHB modelling and recommendations on HCC surveillance should be based on precise disease progression rates.

–  Natasha von Roenn, MD
abstract

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

Antiviral treatment criteria are based on disease progression risk, and hepatocellular carcinoma (HCC) surveillance recommendations for patients with chronic hepatitis B (CHB) without cirrhosis is based on an annual incidence threshold of 0.2%. However, accurate and precise disease progression estimate data are limited. Thus, we aimed to determine rates of cirrhosis and HCC development stratified by age, sex, treatment status, and disease activity based on the 2018 American Association for the Study of Liver Diseases and 2017 European Association for the Study of the Liver guidelines.
METHODS

We analyzed 18,338 patients (8914 treated, 9424 untreated) from 6 centers from the United States and 27 centers from Asia-Pacific countries. The Kaplan-Meier method was used to estimate annual progression rates to cirrhosis or HCC in person-years.
RESULTS

The cohort was 63% male, with a mean age of 46.19 years, with baseline cirrhosis of 14.3% and median follow up of 9.60 years. By American Association for the Study of Liver Diseases criteria, depending on age, sex, and disease activity, annual incidence rates ranged from 0.07% to 3.94% for cirrhosis, from 0.04% to 2.19% for HCC in patients without cirrhosis, and from 0.40% to 8.83% for HCC in patients with cirrhosis. Several subgroups of patients without cirrhosis including males younger than 40 years of age and females younger than 50 years of age had annual HCC risk near or exceeding 0.2%. Similar results were found using European Association for the Study of the Liver criteria.
CONCLUSION

There is great variability in CHB disease progression rates even among "lower-risk" populations. Future CHB modeling studies, public health planning, and HCC surveillance recommendation should be based on more precise disease progression rates based on sex, age, and disease activity, plus treatment status.