未经治疗的不适合治疗的乙型肝炎患者与接受治疗的乙型肝

StephenW

未经治疗的不适合治疗的乙型肝炎患者与接受治疗的乙型肝炎患者的肝脏并发症
Daniel Q Huang、Dong Hyun Lee、Michael H Le、An Le、Yee Hui Yeo、Huy N Trinh、Mimi Chung、Vy Nguyen、Tiffani Johnson、Jian Q Zhang、Clifford Wong、Christopher Wong、Jiayi Li、Ramsey Cheung、Mindie H阮

    PMID: 36070707 DOI: 10.1159/000526933

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抽象的

背景：大量不符合慢性乙型肝炎治疗标准的患者后来发展为肝硬化和肝细胞癌 (HCC) 等不良后果。我们的目的是确定当前的实践指南是否能够充分识别将从抗病毒治疗中受益的慢性乙型肝炎 (CHB) 患者。

方法：我们进行了一项回顾性队列研究，根据标准 AASLD 2018 指南（ALT [U/L] > 70/50 男性/女性加 HBV DNA [IU/mL] > 20,000/2,000 用于 HBeAg+/-）和使用较低阈值的敏感性分析（ALT > 40 U/L 和 HBV DNA > 2,000 国际单位/毫升）。

结果：我们审查了来自加利福尼亚 5 家诊所的 5,840 名患者的记录，并确定了 2,987 名未接受过治疗的非 HCC CHB 患者。其中，271 例患者未接受治疗，不符合治疗条件，514 例患者符合治疗条件并开始治疗，5 年累积肝脏不良发生率分别为 12.5% 和 7.2%，P=0.074。在调整年龄、性别、糖尿病、白蛋白、血小板计数和 HBV DNA 的多变量分析中，与接受治疗的患者相比，未接受治疗的患者发生不良肝脏结局的风险显着更高（调整后的 HR：2.38，95% CI 1.03-5.48，P=0.04）在 AASLD 2018 标准的主要分析中，但在使用较低治疗阈值的敏感性分析中没有（P=0.09）。

结论：与符合条件和接受治疗的患者相比，从未达到抗病毒治疗标准 AASLD 2018 标准且从未接受治疗的患者发生肝硬化和/或 HCC 的风险是其两倍。

作者。巴塞尔 S. Karger AG 出版。

StephenW

Liver complications in untreated treatment-ineligible versus treated treatment-eligible patients with hepatitis B
Daniel Q Huang, Dong Hyun Lee, Michael H Le, An Le, Yee Hui Yeo, Huy N Trinh, Mimi Chung, Vy Nguyen, Tiffani Johnson, Jian Q Zhang, Clifford Wong, Christopher Wong, Jiayi Li, Ramsey Cheung, Mindie H Nguyen

    PMID: 36070707 DOI: 10.1159/000526933

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Abstract

Background: A substantial number of patients who do not meet treatment criteria for chronic hepatitis B later develop adverse outcomes such as cirrhosis and hepatocellular carcinoma (HCC). Our aim was to determine whether current practice guidelines adequately identify chronic hepatitis B (CHB) patients who will benefit from antiviral therapy.

Methods: We performed a retrospective cohort study comparing the incidence of adverse liver outcomes (cirrhosis and/or HCC) in untreated treatment-ineligible (at baseline and throughout follow-up) versus treated treatment-eligible patients according to standard AASLD 2018 guidance (ALT [U/L] > 70/50 for men/women plus HBV DNA [IU/mL] > 20,000/2,000 for HBeAg+/-) and with a sensitivity analyses using a lower threshold (ALT > 40 U/L and HBV DNA > 2,000 IU/mL).

Results: We reviewed records of 5,840 patients from 5 clinics in California and identified 2,987 treatment-naïve non-HCC CHB patients. Of those, 271 patients remained untreated treatment-ineligible, 514 patients were treatment-eligible and initiated treatment, with 5-year cumulative adverse liver incidences of 12.5% vs 7.2%, P=0.074. On multivariable analysis adjusting for age, sex, diabetes, albumin, platelet count and HBV DNA, compared to treated treatment-eligible patients, untreated treatment-ineligible patients had a significantly higher risk of adverse liver outcomes (adjusted HR: 2.38, 95% CI 1.03-5.48, P=0.04) in main analysis by AASLD 2018 criteria, but not in sensitivity analysis using the lower treatment threshold (P=0.09).

Conclusion: Patients never meeting standard AASLD 2018 criteria for antiviral therapy and never treated had twice the risk of developing cirrhosis and/or HCC when compared to eligible and treated patients.

The Author(s). Published by S. Karger AG, Basel.

StephenW

https://www.karger.com/Article/Pdf/526933