Lei Li, Yu-Han Chen, Chun-Lei Fan, Pei-Ling Dong, Bing Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital Affiliated with Capital Medical University, Beijing 100069, China.
World J Gastroenterol. 2013 Dec 7;19(45):8373-81. doi: 10.3748/wjg.v19.i45.8373.
To study the clinical outcome of antiviral therapy in hepatitis B-related decompensated cirrhotic patients.
Three hundred and twelve patients with decompensated hepatitis B cirrhosis were evaluated in a prospective cohort. With two years of follow-up, 198 patients in the group receiving antiviral therapy with nucleos(t)ide analogues and 39 patients in the control group without antiviral treatment were analysed.
Among the antiviral treatment patients, 162 had a complete virological response (CVR), and 36 were drug-resistant (DR). The two-year cumulative incidence of hepatocellular carcinoma (HCC) in the DR patients (30.6%) was significantly higher than that in both the CVR patients (4.3%) and the control group (10.3%) (P < 0.001). Among the DR patients in particular, the incidence of HCC was 55.6% (5/9) in those who failed rescue therapy, which was extremely high. The rtA181T mutation was closely associated with rescue therapy failure (P = 0.006). The Child-Pugh scores of the CVR group were significantly decreased compared with the baseline (8.9 ± 2.3 vs 6.0 ± 1.3, P = 0.043).
This study showed that antiviral drug resistance increased the risk of HCC in decompensated hepatitis B-related cirrhotic patients, especially in those who failed rescue therapy.
研究抗病毒治疗对乙型肝炎相关失代偿性肝硬化患者的临床转归。
前瞻性队列评估了 312 例失代偿性乙型肝炎肝硬化患者。随访 2 年，分析了接受核苷（酸）类似物抗病毒治疗的 198 例患者和未接受抗病毒治疗的 39 例对照组患者。
在抗病毒治疗患者中，162 例患者获得完全病毒学应答（CVR），36 例患者发生耐药（DR）。DR 患者（30.6%）的 2 年肝细胞癌（HCC）累积发生率明显高于 CVR 患者（4.3%）和对照组（10.3%）（P<0.001）。特别是在 DR 患者中，5 例（5/9）未接受挽救治疗的患者 HCC 发生率极高，达 55.6%。rtA181T 突变与挽救治疗失败密切相关（P=0.006）。与基线相比，CVR 组的 Child-Pugh 评分显著降低（8.9±2.3 与 6.0±1.3，P=0.043）。
本研究表明，抗病毒药物耐药增加了乙型肝炎相关失代偿性肝硬化患者发生 HCC 的风险，尤其是在挽救治疗失败的患者中。
