Yasunaka Tetsuya, Ikeda Fusao, Wada Nozomu, Morimoto Yuki, Fujioka Shin-ichi, Toshimori Junichi, Kobashi Haruhiko, Kariyama Kazuya, Morimoto Yoichi, Takayama Hiroki, Seno Tomonori, Takaguchi Koichi, Moriya Akio, Miyatake Hirokazu, Okamoto Ryoichi, Yabushita Kazuhisa, Takaki Akinobu, Yamamoto Kazuhide
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Acta Med Okayama. 2016;70(1):1-12. doi: 10.18926/AMO/53996.
Chronic hepatitis B (CHB) leads to cirrhosis and hepatocellular carcinoma (HCC). With a cohort of 1,206 CHB patients who visited Okayama University Hospital and related hospitals in 2011 and 2012, we compared the incidence rates of HCC among the patients grouped by age, hepatitis B virus (HBV) DNA, hepatitis B e antigen (HBeAg), and treatment. HCCs were observed in 115 patients with the median observation period of 1,687 days. Among the HCC patients aged > 35 years, HBV DNA > 4 log copies/mL and positive HBeAg at diagnosis (n＝184), the HCC incidence rate was 8.4% at 5 years in the entecavir (ETV)-treated patients, 21.8% in the lamivudine (LVD)-treated patients, and 26.4% among the patients not treated with drugs. The cumulative HCC incidence was significantly reduced in the ETV-treated patients compared to those treated with LVD or not treated (p＝0.013). Among the patients aged >35 years with HBV DNA > 4 log copies/mL and negative HBeAg (n＝237), the cumulative HCC incidence was 14.6% in 5 years in ETV group and 13.9% among those not treated with a drug (p＞0.05). Only small numbers of HCCs occurred in other patients. In CHB patients aged > 35 years with HBV DNA > 4 log copies/mL and positive HBeAg, ETV treatment is recommended for the suppression of HCC development.
慢性乙型肝炎（CHB）可导致肝硬化和肝细胞癌（HCC）。我们对2011年和2012年就诊于冈山大学医院及相关医院的1206例CHB患者进行了队列研究，比较了按年龄、乙型肝炎病毒（HBV）DNA、乙型肝炎e抗原（HBeAg）和治疗分组的患者中HCC的发病率。115例患者观察到HCC，中位观察期为1687天。在年龄＞35岁、诊断时HBV DNA＞4 log拷贝/mL且HBeAg阳性的HCC患者中（n＝184），恩替卡韦（ETV）治疗组患者5年时的HCC发病率为8.4%，拉米夫定（LVD）治疗组为21.8%，未接受药物治疗的患者为26.4%。与接受LVD治疗或未接受治疗的患者相比，ETV治疗组患者的累积HCC发病率显著降低（p＝0.013）。在年龄＞35岁、HBV DNA＞4 log拷贝/mL且HBeAg阴性的患者中（n＝237），ETV组5年时的累积HCC发病率为14.6%，未接受药物治疗的患者为13.9%（p＞0.05）。其他患者中仅发生少量HCC。在年龄＞35岁、HBV DNA＞4 log拷贝/mL且HBeAg阳性的CHB患者中，推荐使用ETV治疗以抑制HCC的发生。
