Department of Hepatology, Toranomon Hospital, Tokyo, Japan.
J Med Virol. 2017 Dec;89(12):2144-2148. doi: 10.1002/jmv.24890. Epub 2017 Aug 31.
With rapidly aging population in the world, many elderly patients present with hepatitis B virus (HBV) infection. We conducted a retrospective cohort study involving 359 untreated HBV patients aged 60 and older who were free of hepatocellular carcinoma (HCC) and acute hepatitis at the initial visit, and examined the incidence of HCC and liver-related mortality rate. During the follow-up period of 7.9 years (range, 0-25 years), 26 patients (7.2% of patients) developed HCC, 20 patients died from liver-related diseases (61% of total deaths), including HCC, liver failure, and gastrointestinal bleeding. The cumulative rates of HCC at years 5, 10, and 15 were 6.5%, 15.6%, and 15.6%, respectively. The cumulative rates of mortality from liver-related diseases at years 5, 10, 15 were 3.3%, 12.3%, and 15.7%, respectively. Multivariate analysis identified HBV DNA (≥5.0 Log IU/mL), male gender, and FIB4-Index (≥3.6) as significant independent risk factors for HCC, and alpha-fetoprotein (≥10 ng/mL) as significant independent predictors of liver-related mortality. We conclude that high levels of HBV DNA, progression of liver fibrosis, and male gender are independent risk factors of HCC in untreated patients infected with HBV aged 60 and older.
随着世界人口的迅速老龄化，许多老年患者患有乙型肝炎病毒 (HBV) 感染。我们进行了一项回顾性队列研究，涉及 359 名未经治疗的 HBV 患者，年龄均在 60 岁及以上，且在初次就诊时无肝细胞癌 (HCC) 和急性肝炎，并检查了 HCC 的发病率和肝脏相关死亡率。在 7.9 年的随访期间（范围为 0-25 年），26 名患者（7.2%的患者）发生 HCC，20 名患者死于肝脏相关疾病（总死亡人数的 61%），包括 HCC、肝功能衰竭和胃肠道出血。5 年、10 年和 15 年时 HCC 的累积发生率分别为 6.5%、15.6%和 15.6%。5 年、10 年和 15 年时肝脏相关疾病死亡率的累积发生率分别为 3.3%、12.3%和 15.7%。多变量分析确定 HBV DNA（≥5.0 Log IU/mL）、男性和 FIB4 指数（≥3.6）是 HCC 的显著独立危险因素，而甲胎蛋白（≥10ng/mL）是肝脏相关死亡率的显著独立预测因子。我们的结论是，未经治疗的 HBV 感染且年龄在 60 岁及以上的患者中，HBV DNA 水平高、肝纤维化进展和男性是 HCC 的独立危险因素。
