High risk of hepatocellular carcinoma and death in patients with immune-tolerant-phase chronic hepatitis B
High risk of hepatocellular carcinoma and death in patients with immune-tolerant-phase chronic hepatitis B
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DOI：
10.1136/gutjnl-2017-314904
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发表时间：
2018-05-01
期刊：
影响因子：
24.5
通讯作者：
Lee, Yung Sang
中科院分区：
文献类型：
--
作者：
Kim, Gi-Ae;Lim, Young-Suk;Lee, Yung Sang
目的慢性乙型肝炎（CHB）患者血清HBV DNA水平高与肝细胞癌（HCC）和肝硬化的高风险相关。尽管免疫耐受（IT）期以高循环HBV DNA水平为特征，但抗病毒治疗是否能降低HCC风险和死亡率仍不清楚。本历史队列研究纳入了2000年至2013年韩国一家三级转诊医院HBeAg-(p)阳性且HBV DNA水平高（>= 20,000 IU/mL）且无肝硬化证据的CHB患者。将413名谷丙转氨酶（ALT）水平正常（女性，< 19 IU/mL；男性，< 30 IU/mL）的未经治疗的it期患者的临床结果与1497名接受核苷(t)类似物治疗的免疫活性（IA）期患者（ALT = 80 IU/mL）的临床结果进行比较。结果IT组明显年轻于IA组（平均年龄38岁vs 40岁，p=0.04）。10年估计HCC累积发病率（12.7% vs 6.1%; p=0.001）和死亡/移植（9.7% vs 3.4%; p=0.001）
Objective High serum HBV DNA levels are associated with high risks of hepatocellular carcinoma (HCC) and cirrhosis in patients with chronic hepatitis B (CHB). Although the immune-tolerant (IT) phase is characterised by high circulating HBV DNA levels, it remains unknown whether antiviral treatment reduces risks of HCC and mortality.Design This historical cohort study included HBeAg-(p)ositive patients with CHB with high HBV DNA levels (>= 20 000 IU/mL) and no evidence of cirrhosis at a tertiary referral hospital in Korea from 2000 to 2013. The clinical outcomes of 413 untreated IT-phase patients with normal alanine aminotransferase (ALT) levels (females, < 19 IU/mL; males, < 30 IU/mL) were compared with those of 1497 immune-active (IA)-phase patients (ALT = 80 IU/mL) treated with nucleos(t)ide analogues.Results The IT group was significantly younger than the IA group (mean age, 38 vs 40 years at baseline, p=0.04). The 10-year estimated cumulative incidences of HCC (12.7% vs 6.1%; p=0.001) and death/transplantation (9.7% vs 3.4%; p