不同病毒学应答状态对失代偿期乙型肝炎肝硬化患者预后的影响

嵇笑笑; 李丽; 傅涓涓; 潘修成

doi:10.3969/j.issn.1001-5256.2020.05.017

不同病毒学应答状态对失代偿期乙型肝炎肝硬化患者预后的影响

DOI: 10.3969/j.issn.1001-5256.2020.05.017

徐州医科大学附属医院感染性疾病科

基金项目:

十三五艾滋病和病毒性肝炎等重大传染病防治子课题（2018ZX10302-206）；

详细信息

中图分类号: R512.62;R575.2
计量
- 文章访问数: 741
- HTML全文浏览量: 43
- PDF下载量: 135
- 被引次数: 0
出版历程
- 收稿日期: 2019-12-16
- 出版日期: 2020-05-20

Influence of different virologic responses on the prognosis of patients with decompensated hepatitis B cirrhosis

Department of Infectious Diseases,The Affiliated Hospital of Xuzhou Medical University

Research funding:

摘要

摘要:
目的研究不同病毒学应答状态对失代偿期乙型肝炎肝硬化患者的远期生存率、肝癌发生率的影响。方法连续纳入2010年9月-2016年9月就诊于徐州医科大学附属医院的失代偿期乙型肝炎肝硬化患者378例,根据其抗病毒治疗期间是否HBV DNA持续不可测,分为持续病毒学应答组（n=243例）和非持续病毒学应答组（n=135例）。并依据应用不同抗病毒药物对患者进行分层。记录其基线资料并随访至终点事件发生或研究终点,记录其死亡、肝细胞癌发生情况。符合正态分布的计量资料2组间比较采用独立样本t检验。不符合正态分布的数据2组间比较采用Mann-WhitneyU检验。计数资料组间比较采用χ2检验。采用Kaplan-Meier法绘制生存曲线,log-rank检验生存曲线。结果持续病毒学应答组5年肝癌累积发生率明显低于非持续病毒学应答组,差异有统计学意义（7. 4%vs 19. 3%,χ2=10.627,P=0. 001）。持续病毒学应答组5年无肝移植生存率明显高于非持续病毒学应答组,差异有统计学意义（93. 4%vs 80. 7%,χ2=12.5...
- 乙型肝炎 /
- 肝硬化 /
- 抗病毒药 /
- 持续病毒学应答 /
- 预后
Abstract:
Objective To investigate the influence of different virologic responses on long-term survival rate and incidence rate of liver cancer in patients with decompensated hepatitis B cirrhosis.Methods A total of 378 patients with decompensated hepatitis B cirrhosis who were admitted to The Affiliated Hospital of Xuzhou Medical University from September 2010 to September 2016 were enrolled, and according to whether HBV DNA was continuously undetectable during antiviral therapy, they were divided into sustained virologic response group with 243 patients and non-sustained virologic response group with 135 patients. The patients were stratified according to the application of different antiviral drugs. Baseline data were recorded and the patients were followed up to the occurrence of end events or study endpoint to record death and hepatocellular carcinoma(HCC). The independent samplest-test was used for comparison of normally distributed continuous data between two groups, and the Mann-WhitneyUtest was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used to compare survival rates between groups.Results Compared with the non-sustained virologic response group, the sustained virologic response group had a significantly lower 5-year cumulative incidence rate of HCC(7.4% vs19.3%,χ2 =10.627,P= 0. 001) and a significantly higher 5-year transplant-free survival rate(93. 4% vs 80. 7%,χ2 =12.594,P<0.001). For the sustained virologic response group, there were no significant differences between the entecavir group and the non-entecavir group in the 5-year transplant-free survival rate(94.7% vs 90.2%,χ2 =1.122,P= 0. 290) and the 5-year cumulative incidence rate of liver cancer(6.4 % vs 9.7%,χ2 =0.552,P= 0. 458). For the non-sustained viral response group, there were also no significant differences between the entecavir group and the non-entecavir group in the 5-year transplant-free survival rate(78. 4% vs 82. 8%,χ2 =1.526,P= 0. 217) and the 5-year cumulative incidence rate of liver cancer(21. 5% vs 17. 1%,χ2 =1.844,P= 0. 174).Conclusion Antiviral therapy can improve the prognosis of patients with decompensated hepatitis B cirrhosis, and sustained virologic response can reduce the incidence rate of liver cancer and prolong survival time.
- hepatitis B /
- liver cirrhosis /
- antiviral agents /
- sustained virologic response /
- prognosis

HTML全文

参考文献(15)

[1] FATTOVICH G, GIUSTINA G, SCHALM SW, et al. Occurrence of hepatocellular carcinoma and decompensation in western European patients with cirrhosis type B. The EUROHEP Study Group on Hepatitis B virus and cirrhosis[J]. Hepatology, 1995, 21(1):77-82.

[2] PENG CY, CHIEN RN, LIAW YF. Hepatitis B virus-related decompensated liver cirrhosis:Benefits of antiviral therapy[J]. J Hepatol, 2012, 57(2):442-450.

[3] SINGAL AK, FONTANA RJ. Meta-analysis:Oral anti-viral agents in adults with decompensated hepatitis B virus cirrhosis[J]. Aliment Pharmacol Ther, 2012, 35(6):674-689.

[4] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J]. J Clin Hepatol, 2015, 31(12):1941-1960.(in Chinese）中华医学会肝病学分会，中华医学会感染病学分会．慢性乙型肝炎防治指南（2015年更新版）[J]．临床肝胆病杂志，2015, 31(12):1941-1960.

[5] FATTOVICH G, BORTOLOTTI F, DONATO F. Natural history of chronic hepatitis B:Special emphasis on disease progression and prognostic factors[J]. J Hepatol, 2008, 48(2):335-352.

[6] JANG JW, CHOI JY, KIM YS, et al. Effects of virologic response to treatment on short-and long-term outcomes of patients with chronic hepatitis B virus infection and decompensated cirrhosis[J]. Clin Gastroenterol Hepatol, 2018, 16(12):1954-1963. e3.

[7] FONTANA RJ, HANN HW, PERRILLO RP, et al. Determinants of early mortality in patients with decompensated chronic hepatitis B treated with antiviral therapy[J]. Gastroenterology,2002, 123(3):719-727.

[8] CHEN CJ, YANG HI, SU J, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level[J]. JAMA, 2006, 295(1):65-73.

[9] JU YC, JUN DW, CHOI J, et al. Long term outcome of antiviral therapy in patients with hepatitis B associated decompensated cirrhosis[J]. World J Gastroenterol, 2018, 24(40):4606-4614.

[10] KIM TS, SINN DH, KANG W, et al. Hepatitis B virus DNA levels and overall survival in hepatitis B-related hepatocellular carcinoma patients with low-level viremia[J]. J Gastroenterol Hepatol, 2019, 34(11):2028-2035.

[11] PAPATHEODORIDIS GV, MANOLAKOPOULOS S, TOULOUMI G,et al. Virological suppression does not prevent the development of hepatocellular carcinoma in HBeAg-negative chronic hepatitis B patients with cirrhosis receiving oral antiviral(s)starting with lamivudine monotherapy:Results of the nationwide HEPNET.Greece cohort study[J]. Gut, 2011, 60(8):1109-1116.

[12] HOSAKA T, SUZUKI F, KOBAYASHI M, et al. Long-term entecavir treatment reduces hepatocellular carcinoma incidence in patients with hepatitis B virus infection[J]. Hepatology, 2013, 58(1):98-107.

[13] PAPATHEODORIDIS GV, MANOLAKOPOULOS S, TOULOUMI G, et al. Hepatocellular carcinoma risk in HBeAg-negative chronic hepatitis B patients with or without cirrhosis treated with entecavir:HepNet. Greece cohort[J]. J Viral Hepat, 2015,22(2):120-127.

[14] HOU JL, ZHAO W, LEE C, et al. Outcomes of long-term treatment of chronic HBV infection with entecavir or other agents from a randomized trial in 24 countries[J]. Clin Gastroenterol Hepatol, 2020, 18(2):457-467. e21.

[15] NAM JY, CHANG Y, CHO H, et al. Delayed viral suppression during antiviral therapy is associated with increased hepatocellular carcinoma rates in HBeAg-positive high viral load chronic hepatitis B[J]. J Viral Hepat, 2018, 25(5):552-560.

施引文献

资源附件(0)

访问统计