Chongqing Medical University, School of Public Health, Department of Epidemiology, Chongqing, China.
Chongqing Medical and Pharmaceutical College, Chongqing, China.
Rev Inst Med Trop Sao Paulo. 2024 May 13;66:e27. doi: 10.1590/S1678-9946202466027. eCollection 2024.
Despite good hepatitis B virus (HBV) inhibition by nucleoside analogs (NAs), cases of hepatocellular carcinoma (HCC) still occur. This study proposed a non-invasive predictive model to assess HCC risk in patients with chronic hepatitis B (CHB) receiving NAs treatment. Data were obtained from a hospital-based retrospective cohort registered on the Platform of Medical Data Science Academy of Chongqing Medical University, from 2013 to 2019. A total of 501 patients under NAs treatment had their FIB-4 index updated semiannually by recalculation based on laboratory values. Patients were divided into three groups based on FIB-4 index values: < 1.45, 1.45-3.25, and ≥ 3.25. Subsequently, HCC incidence was reassessed every six months using Kaplan-Meier curves based on the updated FIB-4 index. The median follow-up time of CHB patients after receiving NAs treatment was 2.5 years. HCC incidences with FIB-4 index < 1.45, 1.45-3.25, and ≥ 3.25 were 1.18%, 1.32%, and 9.09%, respectively. Dynamic assessment showed that the percentage of patients with FIB-4 index < 1.45 significantly increased semiannually (P < 0.001), and of patients with FIB-4 index ≥ 3.25 significantly decreased (P < 0.001). HCC incidence was the highest among patients with FIB-4 index ≥ 3.25. The FIB-4 index effectively predicted HCC incidence, and its dynamic assessment could be used for regular surveillance to implement early intervention and reduce HCC risk.
尽管核苷类似物 (NAs) 能很好地抑制乙型肝炎病毒 (HBV)，但仍会发生肝细胞癌 (HCC)。本研究提出了一种非侵入性预测模型，以评估接受 NAs 治疗的慢性乙型肝炎 (CHB) 患者的 HCC 风险。数据来自于重庆医科大学医学数据科学学院医院的基于回顾性队列研究，时间为 2013 年至 2019 年。共有 501 名接受 NAs 治疗的患者，根据实验室值重新计算了半年度 FIB-4 指数更新。根据 FIB-4 指数值将患者分为三组：<1.45、1.45-3.25 和≥3.25。随后，根据更新的 FIB-4 指数，使用 Kaplan-Meier 曲线每六个月重新评估 HCC 发生率。接受 NAs 治疗后 CHB 患者的中位随访时间为 2.5 年。FIB-4 指数<1.45、1.45-3.25 和≥3.25 的 HCC 发生率分别为 1.18%、1.32%和 9.09%。动态评估显示，FIB-4 指数<1.45的患者比例每半年显著增加（P<0.001），FIB-4 指数≥3.25的患者比例显著降低（P<0.001）。FIB-4 指数≥3.25的患者 HCC 发生率最高。FIB-4 指数能有效预测 HCC 发生率，其动态评估可用于定期监测，实施早期干预，降低 HCC 风险。
