Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan.
Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan.
J Formos Med Assoc. 2021 Jan;120(1 Pt 3):621-628. doi: 10.1016/j.jfma.2020.07.019. Epub 2020 Jul 24.
BACKGROUND/PURPOSE: Effective antiviral-therapy can reduce the risk of liver cirrhosis related hepatocellular carcinoma in patients with chronic hepatitis B and hepatitis C. Yet, the difference of hepatocellular carcinoma development in chronic hepatitis B and hepatitis C patients with cirrhosis after effective antiviral therapy treatment is unknown. In this study, We comprehensive explored the difference among them.
1363 patients with cirrhosis and hepatitis B virus treated with nucleos(t)ide analogues (NUCs) with completely suppressed virus, and patients with cirrhosis and hepatitis C virus treated with pegylated interferon (peg-IFN)/ribavirin (RBV) combination therapy who achieved sustained virologic response were enrolled.
Total 261 developed hepatocellular carcinoma within a median follow-up of 4.25 years. Univariate analysis, patients developed hepatocellular carcinoma tended to be of older age, and had lower platelet counts, were chronic hepatitis B carriers, and had higher serum alfa-fetoprotein (AFP) (≥20 ng/mL), FIB-4 index and APRI scores. Subsequent multivariate analysis revealed older age, lower platelet counts, high AFP levels and chronic hepatitis B carriers were independent risk factors of hepatocellular carcinoma.
Our findings identify that chronic hepatitis B patients were with a higher risk of hepatocellular carcinoma compared to chronic hepatitis C patients after achieving virological response. Special attention should be paid to those patients.
背景/目的：有效的抗病毒治疗可以降低慢性乙型肝炎和丙型肝炎患者肝硬化相关肝细胞癌的风险。然而，有效的抗病毒治疗后肝硬化的慢性乙型肝炎和丙型肝炎患者肝癌发展的差异尚不清楚。在这项研究中，我们全面探讨了它们之间的差异。
纳入了 1363 例接受核苷（酸）类似物（NUCs）治疗且病毒完全抑制的乙型肝炎病毒肝硬化患者，以及接受聚乙二醇干扰素（peg-IFN）/利巴韦林（RBV）联合治疗且获得持续病毒学应答的丙型肝炎病毒肝硬化患者。
在中位随访 4.25 年期间，共有 261 例患者发生了肝细胞癌。单因素分析显示，发生肝细胞癌的患者年龄较大，血小板计数较低，为慢性乙型肝炎携带者，血清甲胎蛋白（AFP）（≥20ng/ml）、FIB-4 指数和 APRI 评分较高。随后的多因素分析显示，年龄较大、血小板计数较低、AFP 水平较高和慢性乙型肝炎携带者是肝细胞癌的独立危险因素。
我们的研究结果表明，与丙型肝炎患者相比，乙型肝炎患者在获得病毒学应答后发生肝细胞癌的风险更高。应特别关注这些患者。
