Raffetti Elena, Fattovich Giovanna, Donato Francesco
Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
Department of Medicine, University of Verona, Verona, Italy.
Liver Int. 2016 Sep;36(9):1239-51. doi: 10.1111/liv.13142. Epub 2016 May 22.
BACKGROUND & AIMS: In the natural history of hepatitis B virus (HBV) chronic infection, the hepatocellular carcinoma (HCC) risk is unclear. We assessed incidence and predictors of HCC by a systematic review and meta-analysis.
We included longitudinal studies and randomized controlled trials assessing HCC incidence in untreated patients with HBV chronic infection. Incidence rates and their 95% confidence intervals were extracted by each study and pooled together in random effects models.
Sixty-six studies were included with a total of 347 859 patients. According to liver disease status, the summary incidence rates were in Europe, North America and East Asia, respectively: (a) asymptomatic carriers: 0.07 (95% confidence interval: 0.05-0.09), 0.19 (0.07-0.31) and 0.42 (0.21-0.63) per 100 person-years, respectively; (b) inactive carriers: 0.03 (0.0-0.10), 0.17 (0.02-0.62) and 0.06 (0.02-0.10), respectively; (c) chronic hepatitis: 0.12 (0.0-0.27), 0.48 (0.22-0.91) and 0.49 (0.32-0.66), respectively; (d) compensated cirrhosis (Child-Pugh A): 2.03 (1.30-2.77), 2.89 (1.23-4.55) and 3.37 (2.48-4.26) respectively. Multivariate meta-regression showed a significant increase in incidence rates for age, and for status of a symptomatic carrier, chronic hepatitis and compensated cirrhosis compared to inactive carrier, but not for geographical area after adjusting for age. An increase in the incidence rates was also observed for alcohol intake ≥60 g/dl, HBV genotype C with respect to B and HBV-DNA serum levels >2000 IU/ml, in Asian studies.
Hepatocellular carcinoma risk in untreated subjects with HBV chronic infection is strongly related with age and liver disease status.
在乙型肝炎病毒（HBV）慢性感染的自然病程中，肝细胞癌（HCC）风险尚不清楚。我们通过系统评价和荟萃分析评估了HCC的发病率及预测因素。
我们纳入了评估未经治疗的HBV慢性感染患者HCC发病率的纵向研究和随机对照试验。每项研究提取发病率及其95%置信区间，并汇总到随机效应模型中。
纳入66项研究，共347859例患者。根据肝病状态，欧洲、北美和东亚的汇总发病率分别为：（a）无症状携带者：每100人年分别为0.07（95%置信区间：0.05 - 0.09）、0.19（0.07 - 0.31）和0.42（0.21 - 0.63）；（b）非活动性携带者：分别为0.03（0.0 - 0.10）、0.17（0.02 - 0.62）和0.06（0.02 - 0.10）；（c）慢性肝炎：分别为0.12（0.0 - 0.27）、0.48（0.22 - 0.91）和0.49（0.32 - 0.66）；（d）代偿期肝硬化（Child-Pugh A级）：分别为2.03（1.30 - 2.77）、2.89（1.23 - 4.55）和3.37（2.48 - 4.26）。多变量荟萃回归显示，与非活动性携带者相比，年龄、无症状携带者状态、慢性肝炎和代偿期肝硬化状态的发病率显著增加，但在调整年龄后，地理区域对发病率无影响。在亚洲研究中，酒精摄入量≥60 g/dl、HBV C基因型相对于B基因型以及血清HBV-DNA水平>2000 IU/ml时，发病率也有所增加。
未经治疗的HBV慢性感染患者的肝细胞癌风险与年龄和肝病状态密切相关。
