Faculty of Medicine, Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
J Gastroenterol Hepatol. 2020 Sep;35(9):1610-1618. doi: 10.1111/jgh.15007. Epub 2020 Feb 17.
Improvement in Model for End-Stage Liver Disease (MELD) score during antiviral treatment is associated with reduced hepatic decompensation and death in patients with chronic hepatitis B (CHB)-related cirrhosis. We aimed to identify factors associated with transplant-free survival and on-treatment MELD score improvement.
We identified patients with CHB-related cirrhosis and MELD score ≥ 15 at the start of entecavir and/or tenofovir disoproxil fumarate treatment between 2005 and 2017. The primary endpoint was transplant-free survival at month 6. The secondary endpoints at month 6 were transplant-free survival with > 5-point improvement in MELD score and transplant-free survival with MELD score < 15.
Of 999 cirrhotic CHB patients, 605 (60.6%) achieved transplant-free survival at month 6. Proportion of transplant-free survival at month 6 stabilized at 10% in patients with high MELD. Patients who achieved transplant-free survival at month 6 were younger, had lower MELD score, lower alanine aminotransferase (ALT), and higher albumin at baseline. Of 605 patients with transplant-free survival, 276 (45.6%) achieved > 5-point improvement in MELD score; 183 (30.2%) had 1-point to 5-point improvement in MELD score; 146 (24.1%) had no improvement or a worsened MELD score. Also, 321 (53.1%) patients with transplant-free survival had a MELD score < 15 at month 6.
On top of lower MELD score, patients with CHB-related cirrhosis who are younger, have higher albumin, and lower ALT are more likely to achieve transplant-free survival after 6 months of antiviral treatment.
慢性乙型肝炎（CHB）相关肝硬化患者在抗病毒治疗期间 MELD 评分改善与肝性失代偿和死亡减少相关。本研究旨在确定与无移植生存率和治疗期间 MELD 评分改善相关的因素。
我们在 2005 年至 2017 年间，确定了开始使用恩替卡韦和/或替诺福韦酯治疗时 MELD 评分≥15 的 CHB 相关肝硬化患者。主要终点是治疗 6 个月时的无移植生存率。次要终点是 MELD 评分改善>5 分且无移植生存率，以及 MELD 评分<15 且无移植生存率。
在 999 例肝硬化 CHB 患者中，605 例（60.6%）在治疗 6 个月时无移植生存率。MELD 评分较高的患者，6 个月时无移植生存率的比例在 10%稳定。6 个月时无移植生存率的患者年龄较小，MELD 评分较低，丙氨酸转氨酶（ALT）较低，白蛋白较高。在 605 例无移植生存率的患者中，276 例（45.6%）MELD 评分改善>5 分；183 例（30.2%）MELD 评分改善 1 至 5 分；146 例（24.1%）MELD 评分无改善或恶化。此外，321 例（53.1%）无移植生存率的患者在 6 个月时 MELD 评分<15。
除了较低的 MELD 评分外，年轻、白蛋白较高、ALT 较低的 CHB 相关肝硬化患者在抗病毒治疗 6 个月后更有可能实现无移植生存率。
