Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, and Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Gastroenterology. 2011 Oct;141(4):1240-8, 1248.e1-2. doi: 10.1053/j.gastro.2011.06.036. Epub 2011 Jun 22.
BACKGROUND & AIMS: It is not clear whether risk for hepatocellular carcinoma can be accurately determined from long-term changes in serum levels of hepatitis B virus (HBV) DNA or alanine aminotransferase (ALT).
We measured serum levels of HBV DNA and ALT at enrollment and during follow-up analysis of 3160 participants in the REVEAL-HBV study. Development of hepatocellular carcinoma was determined from follow-up examinations and computerized linkage with National Cancer Registry and National Death Certification profiles. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models.
During 38,330 person-years of follow-up, 81 participants developed hepatocellular carcinoma (incidence rate, 211.3/100,000 person-years). The risk for hepatocellular carcinoma was only slightly higher for participants whose follow-up levels of HBV DNA spontaneously decreased to <10,000 copies/mL compared with those with baseline levels of HBV DNA<10,000 copies/mL (control group; HR, 2.25; 95% CI, 0.68-7.37). Compared with the control group, the HRs (95% CI) for long-term levels of HBV DNA that persisted at 10,000 to 100,000 copies/mL, decreased to/persisted at 100,000 to 1,000,000 copies/mL, or decreased to/persisted at 1,000,000 to 10,000,000 copies/mL were 3.12 (1.09-8.89), 8.85 (3.85-20.35), and 16.78 (7.33-38.39), respectively. A gradient in ALT level was significantly associated with hepatocellular carcinoma risk: from all low-normal, to ever high-normal, to transient abnormal, to persistent abnormal (Ptrend<.001).
Long-term changes in serum levels of HBV DNA and ALT are independent predictors of risk for hepatocellular carcinoma. Regular monitoring of levels of HBV DNA and ALT is important in clinical management of chronic carriers of HBV.
目前尚不清楚乙型肝炎病毒 (HBV) DNA 或丙氨酸氨基转移酶 (ALT) 的血清水平的长期变化是否能准确预测肝细胞癌的风险。
我们在 REVEAL-HBV 研究中对 3160 名参与者进行了入组时和随访分析时的 HBV DNA 和 ALT 血清水平检测。通过随访检查以及与国家癌症登记处和国家死亡证明档案的计算机链接确定肝细胞癌的发生情况。使用 Cox 回归模型估计多变量调整后的风险比 (HR) 和 95%置信区间 (CI)。
在 38330 人年的随访期间，有 81 名参与者发生了肝细胞癌 (发病率为 211.3/100000 人年)。与基线 HBV DNA<10000 拷贝/mL 的参与者相比，HBV DNA 随访水平自发下降至<10000 拷贝/mL 的参与者发生肝细胞癌的风险仅略高 (对照组；HR，2.25；95%CI，0.68-7.37)。与对照组相比，HBV DNA 长期水平在 10000 至 1000000 拷贝/mL 持续、下降至/persisted 1000000 至 10000000 拷贝/mL 或下降至/persisted 10000000 至 100000000 拷贝/mL 的 HR（95%CI）分别为 3.12（1.09-8.89）、8.85（3.85-20.35）和 16.78（7.33-38.39）。ALT 水平的梯度与肝细胞癌风险显著相关：从所有低正常、到曾经高正常、到短暂异常、到持续异常（Ptrend<.001）。
HBV DNA 和 ALT 血清水平的长期变化是肝细胞癌风险的独立预测因素。定期监测 HBV 携带者的 HBV DNA 和 ALT 水平对其临床管理非常重要。
