Antibody to hepatitis B core antigen and risk for hepatitis C-related hepatocellular carcinoma: A prospective study
Antibody to hepatitis B core antigen and risk for hepatitis C-related hepatocellular carcinoma: A prospective study
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DOI：
10.7326/0003-4819-146-9-200705010-00008
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发表时间：
2007-05-01
影响因子：
39.2
通讯作者：
Chiba, Tsutomu
中科院分区：
文献类型：
--
作者：
Ikeda, Kazuki;Marusawa, Hiroyuki;Chiba, Tsutomu
背景：既往暴露于乙型肝炎病毒（HBV）和隐匿性 HBV 感染可能在丙型肝炎病毒（HCV）相关慢性肝病患者发生肝细胞癌（HCC）过程中发挥重要作用。目的：前瞻性研究乙型肝炎核心抗原（抗-HBc）抗体与 HCV 相关慢性肝病患者临床结果之间的关联。设计：前瞻性观察研究。地点：京都大学医院和日本 14 家地区核心医院。参与者：872 名慢性 HCV 感染患者（597 名慢性肝炎患者和 275 名肝硬化患者）。测量：随访中 HCC 的发病率（1995 年至 2005 年）。结果：872 名入组患者中仅对 846 名患者进行了随访。随访期间，846 例患者中有 237 例（28.0%）发生肝细胞癌。在肝硬化患者中，141 名具有抗-HBc 的患者中有 85 名 (60.3%) 被诊断为 HCC，而 129 名没有 HBV 相关血清学标志物的患者中有 58 名 (45.0%) 被诊断为 HCC。在接受干扰素单药治疗的 224 例慢性肝炎患者中，92 例（41.1%）HCV RNA 持续或短暂消失。对干扰素治疗有病毒学反应的抗 HBc 阴性患者均未发展为 HCC，而对干扰素有病毒学反应的 37 名抗 HBc 阳性患者中有 4 人 (10.8%) 被诊断为癌症。在使用 Cox 比例风险模型的多变量分析中，血清学检测中的抗 HBc 阳性结果是肝硬化患者的独立危险因素（发病率比，1.58 [95% Cl，1.12 至 2.22]）。 局限性：该研究仅纳入了 1 项研究开始时吸烟和饮酒的评估，并且没有精确确定吸烟或饮酒的持续时间。结论：血清学检测中的抗 HBc 阳性结果是HCV 相关肝硬化患者中 HCC 高风险的标志物。与抗 HBc 阴性的慢性丙型肝炎患者相比，干扰素治疗在预防 HCC 方面的效果可能不如抗 HBc 阳性的慢性丙型肝炎患者。
Background: Previous exposure to hepatitis B virus (HBV) and occult HBV infection may have an important role in the development of hepatocellular carcinoma (HCC) in patients with chronic liver disease related to hepatitis C virus (HCV).Objective: To prospectively study the association between antibody to hepatitis B core antigen (anti-HBc) and clinical outcomes in patients with HCV-related chronic liver disease.Design: Prospective observational study.Setting: Kyoto University Hospital and 14 regional core hospitals in Japan. Participants: 872 patients with chronic HCV infection (597 with chronic hepatitis and 275 with cirrhosis).Measurements: Incidence of HCC on follow-up (from 1995 to 2005).Results: Only 846 of the 872 enrolled patients were followed. Hepatocellular carcinoma occurred in 237 of 846 patients (28.0%) during follow-up. Among patients with cirrhosis, HCC was diagnosed in 85 of 141 patients (60.3%) with anti-HBc and 58 of 129 patients (45.0%) without HBV-related serologic markers. Of 224 patients with chronic hepatitis who had interferon monotherapy, 92 (41.1%) had sustained or transient disappearance of HCV RNA. None of the anti-HBc-negative patients who had a virologic response to interferon therapy developed HCC, whereas cancer was diagnosed in 4 of 37 anti-HBc-positive patients (10.8%) with a virologic response to interferon. On multivariate analysis using a Cox proportional hazards model, anti-HBc-positive results on serologic testing was an independent risk factor in patients with cirrhosis (incidence rate ratio, 1.58 [95% Cl, 1.12 to 2.22]).Limitations: The study included only 1 assessment of smoking and alcohol consumption at study entry and did not precisely determine the duration of smoking or alcohol use.Conclusions: Anti-HBc-positive results on serologic testing are a marker of high risk for HCC among patients with HCV-related cirrhosis. Interferon therapy might be less effective in preventing HCC among patients with chronic hepatitis C who are anti-HBc-positive than in those with chronic hepatitis C who are anti-HBc-negative.