在 HBV 相关肝硬化的恩替卡韦治疗期间，ALT 与实现亚肝硬化

StephenW

在 HBV 相关肝硬化的恩替卡韦治疗期间，ALT 与实现亚肝硬化和 HCC 无关
Mi Na Kim 1, Jae Seung Lee 2, Hye Won Lee 2, Beom Kyung Kim 2, Jun Yong Park 2, Do Young Kim 2, Sang Hoon Ahn 2, Se Young Jang 3, Won Young Tak 3, Young-Oh Kweon 3 , 朴秀英 3 , 金承佑 4
隶属关系
隶属关系

    1个
    大韩民国城南 CHA 大学医学院 CHA Bundang 医疗中心内科消化内科；临床和转化肝病学实验室，韩国城南。
    2
    韩国首尔延世大学医学院内科；韩国首尔 Severance 医院延世肝脏中心。
    3个
    韩国大邱庆北国立大学医院内科。
    4
    韩国首尔延世大学医学院内科；韩国首尔 Severance 医院延世肝脏中心。电子地址：[email protected]。

    PMID：36375797 DOI：10.1016/j.cgh.2022.10.035

抽象的

背景和目的：我们调查了恩替卡韦 (ETV) 治疗期间的基线和治疗中丙氨酸氨基转移酶 (ALT) 水平是否与乙型肝炎病毒 (HBV) 患者实现亚肝硬化 (LS) 和肝细胞癌 (HCC) 发展相关-相关的肝硬化。

方法：我们分析了 347 名初治 HBV 相关肝硬化患者的数据，这些患者在 2006 年至 2011 年期间开始 ETV，随访时间超过 5 年，未发生 HCC。研究结果是在 5 年 ETV 时实现亚肝硬化 LS，以及在 ETV 5 年后发展为 HCC 的风险。通过瞬时弹性成像将亚肝硬化 LS 定义为 <12 千帕。

结果：经过 5 年的 ETV，227 名 (65.4%) 患者达到了肝硬化下 LS。在 9.2 年的中位随访期间，49 名 (14.1%) 患者在接受 ETV 治疗 5 年后发展为 HCC。基线、1 年和 5 年 ETV 的 ALT 水平与 5 年 ETV 时实现亚肝硬化 LS 的概率或 ETV 5 年后发展为 HCC 的风险无关（均 P>0.05）。在 5 年 ETV 达到亚肝硬化 LS 的患者发生 HCC 的风险显着低于未达到的患者（调整后的风险比=0.33；95% 置信区间，0.17-0.64；P=0.001）。

结论：基线和治疗中的 ALT 水平与 5 年 ETV 达到亚肝硬化 LS 或 HBV 相关肝硬化患者 5 年 ETV 后发展为 HCC 的风险无关。 ETV 5 年达到肝硬化下 LS 与 ETV 5 年后发生 HCC 的风险降低独立相关。

关键词：丙氨酸氨基转移酶；慢性乙型肝炎；肝硬化;肝细胞癌；肝硬化下的肝硬化。

版权所有 © 2022 AGA 研究所。 Elsevier Inc. 出版。保留所有权利。

StephenW

ALT is not associated with achieving subcirrhotic liver stiffness and HCC during entecavir therapy in HBV-related cirrhosis
Mi Na Kim  1 , Jae Seung Lee  2 , Hye Won Lee  2 , Beom Kyung Kim  2 , Jun Yong Park  2 , Do Young Kim  2 , Sang Hoon Ahn  2 , Se Young Jang  3 , Won Young Tak  3 , Young-Oh Kweon  3 , Soo Young Park  3 , Seung Up Kim  4
Affiliations
Affiliations

    1
    Division of Gastroenterology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea; Clinical and Translational Hepatology Laboratory, Seongnam, Republic of Korea.
    2
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
    3
    Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
    4
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea. Electronic address: [email protected].

    PMID: 36375797 DOI: 10.1016/j.cgh.2022.10.035

Abstract

Background & aims: We investigated whether baseline and on-treatment alanine aminotransferase (ALT) levels during entecavir (ETV) therapy are associated with achieving subcirrhotic liver stiffness (LS) and hepatocellular carcinoma (HCC) development in patients with hepatitis B virus (HBV)-related cirrhosis.

Methods: We analyzed data from 347 treatment-naïve patients with HBV-related cirrhosis, who started ETV between 2006 and 2011 and were followed up for >5 years without developing HCC. The study outcomes were achieving subcirrhotic LS at 5 years of ETV, and risk of HCC development beyond 5 years of ETV. Subcirrhotic LS was defined as <12 kilopascals by transient elastography.

Results: After 5 years of ETV, 227 (65.4%) patients achieved subcirrhotic LS. During a median follow-up of 9.2 years, 49 (14.1%) patients developed HCC beyond 5 years of ETV. ALT levels at baseline, 1 year, and 5 years of ETV were not associated with the probability of achieving subcirrhotic LS at 5 years of ETV or risk of HCC development beyond 5 years of ETV (all P>0.05). Patients achieving subcirrhotic LS at 5 years of ETV had significantly lower risk of HCC development than those who did not (adjusted hazard ratio=0.33; 95% confidence interval, 0.17-0.64; P=0.001).

Conclusions: Baseline and on-treatment ALT levels were not associated with achieving subcirrhotic LS at 5 years of ETV, or risk of HCC development beyond 5 years of ETV in patients with HBV-related cirrhosis. Achieving subcirrhotic LS at 5 years of ETV was independently associated with lower risk of HCC development beyond 5 years of ETV.

Keywords: alanine aminotransferase; chronic hepatitis B; cirrhosis; hepatocellular carcinoma; subcirrhotic liver stiffness.

Copyright © 2022 AGA Institute. Published by Elsevier Inc. All rights reserved.