Department of Internal Medicine, Kyung Hee University Hospital, Seoul 02447, South Korea.
Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, South Korea.
World J Gastroenterol. 2023 Jun 28;29(24):3843-3854. doi: 10.3748/wjg.v29.i24.3843.
Research exploring the influence of healthier lifestyle modification (LSM) on the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) is limited.
To emulate a target trial to determine the effect of LSM on HCC incidence and mortality among patients with CHB by large-scale population-based observational data.
Among the patients with CHB enrolled in the Korean National Health Insurance Service between January 1, 2009, and December 31, 2017, those aged ≥ 20 years who drank alcohol, smoked cigarettes, and were sedentary were analyzed. Exposure included at least one LSM, including alcohol abstinence, smoking cessation, and regular exercise. The primary outcome was HCC development, and the secondary outcome was liver-related mortality. We used 2:1 propensity score matching to account for covariates.
With 48766 patients in the LSM group and 103560 in the control group, the adjusted hazard ratio (HR) for incident HCC and liver-related mortality was 0.92 [95% confidence interval (CI): 0.87-0.96] and 0.92 (95%CI: 0.86-0.99) in the LSM group, respectively, compared with the control group. Among the LSM group, the adjusted HR (95%CI) for incident HCC was 0.84 (0.76-0.94), 0.87 (0.81-0.94), and 1.08 (1.00-1.16) for alcohol abstinence, smoking cessation, and regular exercise, respectively. The adjusted HR (95%CI) for liver-related mortality was 0.92 (0.80-1.06), 0.81 (0.72-0.91), and 1.15 (1.04-1.27) for alcohol abstinence, smoking cessation, and regular exercise, respectively.
LSM lowered the risk of HCC and mortality in patients with CHB. Thus, active LSM, particularly alcohol abstinence and smoking cessation, should be encouraged in patients with CHB.
针对更健康的生活方式改变（LSM）对慢性乙型肝炎（CHB）患者肝细胞癌（HCC）风险影响的研究有限。
利用大规模基于人群的观察性数据，通过模拟目标试验来确定 LSM 对 CHB 患者 HCC 发病率和死亡率的影响。
在 2009 年 1 月 1 日至 2017 年 12 月 31 日期间参加韩国国家健康保险服务的 CHB 患者中，分析年龄≥20 岁且饮酒、吸烟和久坐的患者。暴露包括至少一种 LSM，包括戒酒、戒烟和定期运动。主要结局是 HCC 的发生，次要结局是与肝脏相关的死亡率。我们使用 2:1 的倾向评分匹配来考虑协变量。
在 LSM 组中，有 48766 名患者，在对照组中有 103560 名患者，与对照组相比，LSM 组 HCC 发生率和与肝脏相关的死亡率的调整后的危险比（HR）分别为 0.92（95%置信区间[CI]：0.87-0.96）和 0.92（95%CI：0.86-0.99）。在 LSM 组中，与对照组相比，HCC 发生率的调整后 HR（95%CI）分别为 0.84（0.76-0.94）、0.87（0.81-0.94）和 1.08（1.00-1.16）。与肝脏相关的死亡率的调整后 HR（95%CI）分别为 0.92（0.80-1.06）、0.81（0.72-0.91）和 1.15（1.04-1.27）。
LSM 降低了 CHB 患者 HCC 和死亡的风险。因此，应鼓励 CHB 患者积极进行 LSM，特别是戒酒和戒烟。
