恩替卡韦或替诺福韦治疗失代偿慢性乙型肝炎患者的可比结

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恩替卡韦或替诺福韦治疗失代偿慢性乙型肝炎患者的可比结果：一项为期 8 年的队列研究

    Kuan-Chieh Lee, Jur-Shan Cheng, Ming-Ling Chang, Rong-Nan Chien & Yun-Fan Liaw

Hepatology International 第 16 卷，第 799–806 页（2022 年）引用这篇文章

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背景/目标

恩替卡韦 (ETV) 和富马酸替诺福韦二吡呋酯 (TDF) 在治疗失代偿期慢性乙型肝炎 (CHB) 患者肝脏相关结局方面的疗效是否具有可比性仍无定论。
方法

对 736 名失代偿期慢性乙型肝炎患者进行了一项为期 8 年的队列研究，其中 65 名接受 TDF 治疗的患者的性别、年龄和终末期肝病（MELD）评分为 1:4，通过倾向评分与 260 名接受 ETV 治疗的患者相匹配-匹配方法。
结果

736 例患者中，男性 574 例（78%），平均年龄 54.3 岁，肝硬化 438 例（59.5%），HBeAg 阳性 147 例（20%），84 例（11.6%）和 652 例（88.4%）分别用 TDF 和 ETV 处理。 652 名接受 ETV 治疗的患者年龄较大，基线 MELD 评分和脑病发生率较高，但 ALT 水平低于接受 TDF 治疗的 84 名患者。肝脏相关死亡率或肝移植的累积发生率（1个月，18.45 vs. 14.01%，p = 0.368；8年，39.74 vs. 34.24%，p = 0.298）和肝细胞癌的累积发生率没有显着差异无论时间点如何，匹配的 260 名 ETV 和 65 名 TDF 治疗患者之间的发展（5 年，7.21 对 13.17%，p = 0.994；8 年，11.60 对 13.17%，p = 0.857）。基线 MELD 评分（子分布风险比 (sHR)：1.063；sHR 的 95% 置信区间 (CI)：1.016-1.112）和肝性脑病（sHR：5.127；95% CI sHR：3.032-8.669）与肝-匹配患者的相关死亡率或肝移植。
结论

ETV 和 TDF 在失代偿期慢性乙型肝炎患者的短期和长期肝脏相关结局中具有相当的疗效，并且基线肝脏储备与结局相关。

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Comparable outcomes of decompensated chronic hepatitis B patients treated with entecavir or tenofovir: an 8-year cohort study

    Kuan-Chieh Lee, Jur-Shan Cheng, Ming-Ling Chang, Rong-Nan Chien & Yun-Fan Liaw

Hepatology International volume 16, pages 799–806 (2022)Cite this article

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Abstract
Background/Aims

Whether the efficacies of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) in treating liver-related outcomes of decompensated chronic hepatitis B (CHB) patients are comparable remained inconclusive.
Methods

An 8-year cohort study of 736 decompensated CHB patients was conducted, and 65 TDF-treated patients were sex, age and model for end-stage liver disease (MELD) scores-1:4 matched with 260 ETV-treated patients through propensity score-matching method.
Results

Of 736 patients, 574 (78%) were male, with a mean age of 54.3 years, 438 (59.5%) had cirrhosis, 147 (20%) were positive for HBeAg, and 84 (11.6%) and 652 (88.4%) were treated with TDF and ETV, respectively. The 652 ETV-treated patients were older, had higher baseline MELD score and rates of encephalopathy, but lower ALT levels than the 84 TDF-treated patients. No significant differences were observed in the cumulative incidences of liver-related mortality or liver transplantation (1-month, 18.45 vs. 14.01%, p = 0.368; 8-year, 39.74 vs. 34.24%, p = 0.298), and hepatocellular carcinoma development (5-year, 7.21 vs.13.17%, p = 0.994; 8-year, 11.60 vs.13.17%, p = 0.857) between the matched 260 ETV- and 65 TDF-treated patients, regardless of time points. Baseline MELD score (subdistribution hazard ratio (sHR): 1.063; 95% confidence interval (CI) of sHR: 1.016–1.112) and hepatic encephalopathy (sHR: 5.127; 95% CI sHR: 3.032–8.669) were independently associated with liver-related mortality or liver transplantation in the matched patients.
Conclusions

ETV and TDF had comparable efficacy in the short- and long-term liver-related outcomes of decompensated CHB patients, and baseline liver reserve was associated with the outcomes.