Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea.
Intervirology. 2010;53(2):111-8. doi: 10.1159/000264201. Epub 2009 Dec 3.
We investigated the pattern of serial HBV DNA levels in known cirrhosis patients and its impact on the development of hepatocellular carcinoma (HCC).
We analyzed a retrospective case/control study based on 352 HCC patients associated with HBV between 2005 and 2007. Prior to HCC development, 49 cirrhosis patients were tested for HBV DNA levels more than once a year (median 4 times) during the follow-up period. Ninety-eight consecutive cirrhosis patients without HCC, matched for age, sex and HBe Ag status were included as controls. Eighty-three patients in both groups had undergone antiviral therapy.
In cirrhosis, the most common HBV DNA pattern was fluctuating (33.3%), followed by persistently high (> or =10(4) copies/ml, 23.8%). Compared to a persistently low pattern (<10(4) copies/ml), the relative risks of HCC in patients with persistently high and fluctuating patterns were 2.650 and 1.475. At multivariate analysis, a persistently high pattern was an independent risk factor for HCC (hazard ratio 3.135). Patients with sustained HBV DNA suppression during antiviral therapy were less likely to develop HCC than those with viral breakthrough/nonresponse.
This study showed that persistent suppression of HBV DNA is also important to prevent the development of HCC in known cirrhosis patients.
我们研究了已知肝硬化患者乙型肝炎病毒（HBV）DNA 水平的变化模式及其对肝细胞癌（HCC）发生的影响。
我们分析了一项基于 2005 年至 2007 年期间 352 例 HBV 相关 HCC 患者的回顾性病例对照研究。在 HCC 发生之前，49 例肝硬化患者在随访期间每年至少进行 4 次 HBV DNA 水平检测。选择同期 98 例年龄、性别和 HBeAg 状态相匹配的无 HCC 肝硬化患者作为对照。两组中共有 83 例患者接受了抗病毒治疗。
在肝硬化中，最常见的 HBV DNA 模式为波动（33.3%），其次为持续高水平（≥10⁴拷贝/ml，23.8%）。与持续低水平模式相比，持续高水平和波动模式患者 HCC 的相对风险分别为 2.650 和 1.475。多因素分析显示，持续高水平模式是 HCC 的独立危险因素（危险比 3.135）。抗病毒治疗期间持续抑制 HBV DNA 的患者发生 HCC 的可能性低于病毒突破/无应答的患者。
本研究表明，持续抑制 HBV DNA 对预防已知肝硬化患者 HCC 的发生也很重要。
Zotero 插件