Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Eur J Gastroenterol Hepatol. 2022 Jan 1;34(1):69-75. doi: 10.1097/MEG.0000000000001915.
Chronic hepatitis B patients positive for hepatitis B e antigen (HBeAg) with high serum hepatitis B virus (HBV) DNA levels but normal alanine aminotransferase (ALT) levels may develop hepatocellular carcinoma (HCC). However, ways to risk stratify are limited.
A retrospective cohort of 651 HBeAg positive, adult patients with high serum HBV DNA levels (>7 log IU/ml) but normal or mildly elevated ALT levels (<80 U/L) were analyzed.
Age and FIB-4 index were independent factors associated with HCC development. When stratified, 5- and 10-year cumulative HCC incidence rates were 0 and 2.0% for patients aged <40 years with FIB-4 index <1.45, and were 5.9 and 32.7% for patients aged ≥40 years with FIB-4 index ≥1.45, respectively (P < 0.001). In patients with normal ALT levels (n = 301), the 10-year HCC incidence rate was 0% for patients aged <40 years with FIB-4 index <1.45, while 5- and 10-years HCC incidence rate was 4.5 and 27.1% for patients aged ≥40 years with FIB-4 index ≥1.45, respectively (P < 0.001).
In patients with high HBV DNA but normal ALT levels, age and FIB-4 index could effectively stratify HCC risk, indicating that these parameters may guide management plans for this population.
乙肝 e 抗原（HBeAg）阳性、血清乙型肝炎病毒（HBV）DNA 水平高但丙氨酸氨基转移酶（ALT）水平正常的慢性乙型肝炎患者可能会发展为肝细胞癌（HCC）。然而，风险分层的方法有限。
对 651 例 HBeAg 阳性、血清 HBV DNA 水平高（>7 log IU/ml）但 ALT 水平正常或轻度升高（<80 U/L）的成年患者进行回顾性队列分析。
年龄和 FIB-4 指数是与 HCC 发展相关的独立因素。分层后，年龄<40 岁且 FIB-4 指数<1.45 的患者 5 年和 10 年累积 HCC 发生率分别为 0 和 2.0%，年龄≥40 岁且 FIB-4 指数≥1.45 的患者分别为 5.9%和 32.7%（P<0.001）。在 ALT 水平正常的患者（n=301）中，年龄<40 岁且 FIB-4 指数<1.45 的患者 10 年 HCC 发生率为 0%，而年龄≥40 岁且 FIB-4 指数≥1.45 的患者 5 年和 10 年 HCC 发生率分别为 4.5%和 27.1%（P<0.001）。
在 HBV DNA 水平高但 ALT 水平正常的患者中，年龄和 FIB-4 指数可以有效地分层 HCC 风险，表明这些参数可能指导该人群的管理计划。
