Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China.
Aliment Pharmacol Ther. 2021 Jan;53(2):321-331. doi: 10.1111/apt.16174. Epub 2020 Nov 22.
It is unknown whether patients with chronic hepatitis B (CHB) who achieved hepatitis B surface antigen (HBsAg) seroclearance spontaneously or following anti-viral therapy have similar clinical outcomes.
To compare the risk of hepatocellular carcinoma (HCC) in patients with CHB who either cleared HBsAg spontaneously or following anti-viral therapy METHODS: Adult CHB-monoinfected patients who cleared HBsAg between January 2000 and March 2019 were identified from a territory-wide database in Hong Kong. Patients with liver transplantation and/or HCC before HBsAg loss were excluded. Patients' demographics, comorbidities, anti-viral treatment, laboratory parameters and HCC development were analysed.
Of 7,124 identified patients with CHB who cleared HBsAg, mean age was 58.1 ± 13.8 years; 4,340 (60.9%) were male; 451 (6.3%) had cirrhosis; 5,917 (83.1%) and 1,207 (16.9%) had spontaneous and nucleos(t)ide analogue (NA)-induced HBsAg seroclearance, respectively. Most patients had normal liver function at HBsAg loss. Patients with NA-induced HBsAg seroclearance were younger, and more likely to be male and cirrhotic than patients with spontaneous HBsAg loss. At a median (interquartile range) follow-up of 4.3 (2.2-7.6) years, 97 (1.6%) and 16 (1.3%) patients with spontaneous and NA-induced HBsAg loss developed HCC, respectively. Patients who achieved NA-induced HBsAg loss had comparable HCC risk as those with spontaneous HBsAg loss (adjusted subdistribution hazard ratio 0.75, 95% CI 0.43-1.32, P = 0.323). The results remained robust in propensity score weighting and matching analyses.
The HCC risk was similarly low after either spontaneous or NA-induced HBsAg seroclearance in a territory-wide cohort of patients with CHB who had cleared HBsAg.
目前尚不清楚慢性乙型肝炎（CHB）患者自发或经抗病毒治疗实现乙肝表面抗原（HBsAg）血清学清除后是否具有相似的临床结局。
比较 CHB 患者自发或经抗病毒治疗后 HBsAg 清除者发生肝细胞癌（HCC）的风险。
从香港全港范围内的数据库中确定 2000 年 1 月至 2019 年 3 月期间 HBsAg 自发或经抗病毒治疗清除的成年 CHB 单感染患者。排除 HBsAg 丢失前接受肝移植和/或 HCC 治疗的患者。分析患者的人口统计学、合并症、抗病毒治疗、实验室参数和 HCC 发展情况。
在确定的 7124 例 HBsAg 清除的 CHB 患者中，平均年龄为 58.1±13.8 岁；4340 例（60.9%）为男性；451 例（6.3%）有肝硬化；5917 例（83.1%）和 1207 例（16.9%）分别为自发和核苷（酸）类似物（NA）诱导的 HBsAg 血清学清除。大多数患者在 HBsAg 丢失时肝功能正常。与自发 HBsAg 丢失患者相比，NA 诱导的 HBsAg 血清学清除患者更年轻，且更可能为男性和肝硬化。中位（四分位间距）随访 4.3（2.2-7.6）年后，自发和 NA 诱导的 HBsAg 丢失患者分别有 97 例（1.6%）和 16 例（1.3%）发生 HCC。NA 诱导的 HBsAg 丢失患者的 HCC 风险与自发 HBsAg 丢失患者相当（调整后的亚分布风险比 0.75，95%CI 0.43-1.32，P=0.323）。倾向评分加权和匹配分析的结果也稳健。
在清除 HBsAg 的 CHB 患者全港范围内队列中，自发或 NA 诱导的 HBsAg 血清学清除后 HCC 风险相似较低。
