验证接受恩替卡韦治疗的乙型肝炎相关失代偿期肝硬化患者

StephenW

验证接受恩替卡韦治疗的乙型肝炎相关失代偿期肝硬化患者的 Baveno VII 补偿标准

    齐王#
    赵红#
    尤登#
    卡尔文·Q·潘
    文燮
    贾继东
    显示所有作者
    显示脚注

开放存取发布时间：2022 年 8 月 26 日 DOI：https://doi.org/10.1016/j.jhep.2022.07.037


    •
    这是 BAVENO VII 再补偿定义在 HBV 肝硬化患者中的首次前瞻性验证。
    •
    肝功能测试的稳定改善被定义为在 Child-Pugh A 中的 MELD < 10 和/或 ALB & INR & TBIL。
    •
    治疗中的 MELD 评分可能比基线 MELD 评分更能预测补偿的概率。
    •
    及时的抗病毒治疗对因 HBV 引起的肝硬化患者有效，即使在严重的情况下也是如此。

抽象的
背景与目标
抗病毒治疗可改善慢性乙型肝炎 (CHB) 患者的临床结局，包括肝硬化患者。在本研究中，我们验证了 Baveno VII 对补偿的定义，并探讨了恩替卡韦治疗的慢性乙型肝炎相关失代偿期肝硬化患者肝功能测试稳定改善的标准。
方法
在这项多中心前瞻性研究中，失代偿（腹水）慢性乙型肝炎相关肝硬化患者入组并接受恩替卡韦治疗 120 周。每 6 个月对患者进行一次临床事件、病毒和生化检测以及超声检查。计算了每个 Baveno VII 标准的补偿率。多元回归模型用于确定补偿的预测因素。最后探讨肝功能检查稳定改善的标准。
结果
在招募的 320 名患者中，283 人完成了为期 120 周的研究，其中 261/283 (92.2%) 的 HBV DNA 水平 <20 IU/ml，171/283 (60.4%) 的腹水、脑病消退并且没有复发静脉曲张出血至少 12 个月。我们确定了终末期肝病模型 <10 和/或 Child-Pugh A 级肝功能测试（白蛋白 >35 g/L，国际标准化比 <1.50 和总胆红素 <34 μmol/L）作为稳定的标准改善肝功能检查。因此，56.2% (159/283) 的患者符合 Baveno VII 的补偿定义，肝功能测试由当前研究定义的稳定改善。
结论
我们的研究定义了 Baveno VII 对 CHB 相关失代偿期肝硬化抗病毒治疗患者再补偿定义所要求的肝功能测试稳定改善的标准。从这项多中心前瞻性研究得出的标准值得在其他病因的肝硬化患者中进一步验证。
总结
肝硬化失代偿标志着肝脏不再能够正常运作（并且症状变得明显）。最近，如果解决了肝病的根本原因（例如病毒性肝硬化的抗病毒药物），则对可能会改善肝功能的个体提出了补偿的想法。在此，我们表明超过 50% 的乙型肝炎相关失代偿期肝硬化患者接受抗病毒药物治疗后可以进行补偿，我们提出了可用于定义再补偿的实验室标准。

StephenW

Validation of Baveno VII criteria for recompensation in entecavir-treated individuals with hepatitis B-related decompensated cirrhosis

    Qi Wang #
    Hong Zhao #
    You Deng #
    Calvin Q. Pan
    Wen Xie
    Jidong Jia
    Show all authors
    Show footnotes

Open AccessPublished:August 26, 2022DOI:https://doi.org/10.1016/j.jhep.2022.07.037


    •
    This is the first prospective validation of the BAVENO VII recompensation definition in cirrhotic patients due to HBV.
    •
    A stable improvement of liver function tests was defined as MELD < 10 and/or ALB & INR & TBIL within Child-Pugh A.
    •
    On-treatment MELD scores may be more predictive of the probability of recompensation than baseline MELD scores.
    •
    Prompt antiviral therapy is effective for cirrhotic patients due to HBV, even under severe conditions.

Abstract
Background & Aims
Antiviral therapy improves the clinical outcomes of patients with chronic hepatitis B (CHB), including those with cirrhosis. In the present study, we validated the Baveno VII definition of recompensation and explored the criteria for stable improvement of liver function tests in entecavir-treated patients with CHB-related decompensated cirrhosis.
Methods
In this multicentre prospective study, patients with decompensated (ascites) CHB-related cirrhosis were enrolled and treated with entecavir for 120 weeks. Patients were followed up for clinical events, viral and biochemical tests, and ultrasonography every 6 months. The recompensation rate per Baveno VII criteria was calculated. Multivariate regression models were used to identify the predictors of recompensation. Finally, the criteria for stable improvement of liver function tests were explored.
Results
Of the 320 recruited patients, 283 completed the 120-week study, with 261/283 (92.2%) achieving HBV DNA levels <20 IU/ml and 171/283 (60.4%) achieving resolution of ascites, encephalopathy, and absence of recurrent variceal bleeding for at least 12 months. We identified model for end-stage liver disease <10 and/or liver function tests within Child-Pugh Class A (albumin >35 g/L, international normalised ratio <1.50 and total bilirubin <34 μmol/L) as the criteria for stable improvement of liver function tests. Accordingly, 56.2% (159/283) of patients fulfilled the Baveno VII definition of recompensation with a stable improvement of liver function tests defined by the current study.
Conclusions
Our study defined the criteria for a stable improvement of liver function tests required by the Baveno VII definition of recompensation in patients with CHB-related decompensated cirrhosis on antiviral therapy. The criteria derived from this multicentre prospective study warrant further validation in patients with cirrhosis of other aetiologies.
Lay summary
Decompensation of cirrhosis marks the point at which the liver is no longer able to function normally (and symptoms become apparent). Recently the idea of recompensation was proposed for individuals who may experience an improvement in liver function if the underlying cause of their liver disease is addressed (e.g. antivirals for viral cirrhosis). Herein, we show that over 50% of patients with hepatitis B-related decompensated cirrhosis treated with antivirals could recompensate and we propose laboratory criteria which could be used to define recompensation.

StephenW

http://www.journal-of-hepatology.eu/article/S0168827822030197/pdf