抗病毒治疗期间两年无并发症可预测立即治疗 HBV 相关失代偿

StephenW

抗病毒治疗期间两年无并发症可预测立即治疗 HBV 相关失代偿期肝硬化的稳定再代偿
何志英 1 , 周嘉玲 1 , 于田 1 , 吴珊珊 1 , 孙亚萌 1 , 欧小娟 1 , 冀东嘉 1 , 王冰琼 1 , 吴小宁 1 , 游红 1
隶属关系
联系

    1
    首都医科大学北京友谊医院国家消化疾病临床研究中心，肝硬化转化医学北京市重点实验室，肝脏研究中心，北京，中国。

    PMID：36227688 DOI：10.1080/00365521.2022.2132532

抽象的

背景和目的：一旦开始抗病毒治疗，失代偿期 HBV 相关肝硬化患者的疾病进展可能会改变甚至逆转。然而，对这些患者的稳定再代偿知之甚少。

方法：在这项回顾性研究中，HBV相关肝硬化患者在首次失代偿性腹水或静脉曲张出血（VH）事件时连续入组，分为立即治疗组、治疗中组和延迟/不治疗组。患者被随访至至少出现第二次失代偿事件或至 2021 年 6 月。再补偿定义为随访期间未发生第二次（进一步）失代偿的患者。

结果：共纳入 130 例 HBV 相关失代偿期肝硬化患者，中位随访时间为 61.0（41.6，72.0）个月。在立即治疗、治疗中和延迟/不治疗组中，第 6 年再补偿的累积发生率为 39.0、9.8 和 6.6（p = 0.001）。即刻治疗组87例患者中，37例（37/87，42.5%）被认为是稳定的再代偿。百分之七十 (35/50) 的第二次失代偿事件发生在前 2 年。在 2 年无失代偿并发症的患者中，约 71.2% (37/52) 维持稳定的再代偿。在 2 年无失代偿并发症或无失代偿并发症的患者中，死亡（和/或移植）和 HCC 的累积发生率分别为 2.9 对 27.3%（HR 9.4，95% CI 2.2-40.0，p = 0.002）和 12.6 对 37.7 % (HR 4.5, 95% CI 1.5-13.3, p = 0.006)。

结论：在失代偿的 HBV 相关肝硬化患者中，约 40% 的即刻治疗组在 6 年的抗病毒治疗期间维持稳定的再代偿。两年无并发症可以预测稳定的再补偿。

关键词：失代偿期肝硬化；乙型肝炎病毒;立即治疗；重新补偿。

StephenW

Two-year free of complications during antiviral therapy predicts stable re-compensation in immediate-treatment HBV-related decompensated cirrhosis
Zhiying He  1 , Jialing Zhou  1 , Yu Tian  1 , Shanshan Wu  1 , Yameng Sun  1 , Xiaojuan Ou  1 , Jidong Jia  1 , Bingqiong Wang  1 , Xiaoning Wu  1 , Hong You  1
Affiliations
Affiliation

    1
    Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China.

    PMID: 36227688 DOI: 10.1080/00365521.2022.2132532

Abstract

Background and aims: Disease progression could be altered or even reversed in decompensated patients with HBV-related cirrhosis once they initiate antiviral therapy. However, little is known about the stable re-compensation in these patients.

Methods: In this retrospective study, HBV-related liver cirrhosis patients were consecutively enrolled at the first decompensated event of ascites or variceal hemorrhage (VH), and divided into immediate-treatment, on-treatment and delayed/no treatment groups. Patients were followed up to at least presence of second decompensation event or to June 2021. Re-compensation was defined as patients who did not occur second (further) decompensation during follow-up.

Results: A total of 130 HBV-related decompensated cirrhotic patients were included with a median follow-up of 61.0 (41.6, 72.0) months. The cumulative incidence of re-compensation at year 6 was 39.0, 9.8 and 6.6 in immediate-treatment, on-treatment and delayed/no treatment group (p = 0.001). Among 87 patients in immediate-treatment group, thirty-seven (37/87, 42.5%) were recognized as stable re-compensation. Seventy percent (35/50) of second decompensated events occurred in the first 2 years. In patients free of 2-year decompensated complications, about 71.2% (37/52) maintained stable re-compensation. The cumulative incidence of death (and/or transplantation) and HCC in patients free of 2-year decompensated complications or not was 2.9 vs. 27.3% (HR 9.4, 95% CI 2.2-40.0, p = 0.002) and 12.6 vs. 37.7% (HR 4.5, 95% CI 1.5-13.3, p = 0.006), respectively.

Conclusions: In decompensated patients with HBV-related cirrhosis, about 40% in immediate-treatment group maintained stable re-compensation during 6 years of antiviral therapy. Two-year free of complications could predict stable re-compensation.

Keywords: Decompensated cirrhosis; Hepatitis B Virus; immediate-treatment; re-compensation.