抗病毒治疗对乙型肝炎病毒相关失代偿期肝硬化且 DNA 不可检测患者的临床疗效。

The clinical effect of antiviral therapy in patients with hepatitis B virus-related decompensated cirrhosis and undetectable DNA.

机构信息

Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea.

Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.

出版信息

J Gastroenterol Hepatol. 2023 May;38(5):716-723. doi: 10.1111/jgh.16132. Epub 2023 Feb 20.

DOI:10.1111/jgh.16132

PMID:36681856

Abstract

BACKGROUND AND AIM

Antiviral therapy (AVT) is the mainstay of hepatitis B virus (HBV) management. We investigated whether AVT improves the outcomes of HBV-related decompensated cirrhosis and undetectable HBV-DNA.

METHODS

Between 2000 and 2017, treatment-naïve patients with HBV-related decompensated cirrhosis and undetectable HBV-DNA were recruited from two tertiary hospitals. The endpoints included death and hepatocellular carcinoma (HCC).

RESULTS

A total of 429 patients were analyzed (50 and 379 patients in the AVT and non-AVT groups, respectively). Patients in the AVT group were significantly younger and had higher alanine aminotransferase and alpha-fetoprotein levels than those in the non-AVT group (all P < 0.05). During follow-up (median 49.6 months), 98 patients died and 105 developed HCC. The cumulative incidence rates of death (2.0%, 4.1%, and 6.4%, and 4.9%, 7.2%, and 10.2% at 6 months, 1 year, and 2 years, respectively) and HCC (8.6%, 15.8%, and 26.4% vs 1.6%, 7.7%, and 24.4% at 1, 2, and 5 years, respectively) were statistically comparable between the AVT and non-AVT groups (all P > 0.05). Using Cox regression analysis, AVT was not significantly associated with death nor HCC (all P > 0.05). Similar results were observed after balancing baseline characteristics with inverse probability of treatment weighting. In the non-AVT group, the cumulative incidence rates of HBV-DNA detection at 6 months, 1 year, and 2 years were 2.0%, 3.1%, and 6.4%, respectively.

CONCLUSIONS

Antiviral therapy did not attenuate the risk of death nor HCC in patients with HBV-related decompensated cirrhosis and undetectable HBV-DNA.

摘要

背景与目的

抗病毒治疗（AVT）是乙型肝炎病毒（HBV）管理的主要方法。我们研究了 AVT 是否可以改善 HBV 相关失代偿性肝硬化和不可检测 HBV-DNA 的结局。

方法

在 2000 年至 2017 年期间，从两家三级医院招募了治疗初治的 HBV 相关失代偿性肝硬化和不可检测 HBV-DNA 的患者。终点包括死亡和肝细胞癌（HCC）。

结果

共分析了 429 例患者（AVT 组和非 AVT 组分别为 50 例和 379 例）。AVT 组患者明显比非 AVT 组年轻，且丙氨酸氨基转移酶和甲胎蛋白水平更高（均 P<0.05）。在随访期间（中位 49.6 个月），98 例患者死亡，105 例患者发生 HCC。死亡的累积发生率（2.0%、4.1%和 6.4%，4.9%、7.2%和 10.2%分别在 6 个月、1 年和 2 年）和 HCC（8.6%、15.8%和 26.4%比 1.6%、7.7%和 24.4%分别在 1 年、2 年和 5 年）在 AVT 组和非 AVT 组之间统计学上无差异（均 P>0.05）。使用 Cox 回归分析，AVT 与死亡或 HCC 无显著相关性（均 P>0.05）。在使用逆概率治疗加权法平衡基线特征后，也得到了相似的结果。在非 AVT 组中，HBV-DNA 在 6 个月、1 年和 2 年的检测累积发生率分别为 2.0%、3.1%和 6.4%。