BACKGROUND & AIMS:
BACKGROUND & AIMS:Some patients with chronic hepatitis B virus (HBV) infection progress to hepatocellular carcinoma (HCC). However, the long-term effect of nucleos(t)ide analogue (NA) therapy on progression to HCC is unclear.
METHODS:Therefore, we compared chronic hepatitis B patients who received NA therapy to those who did not, using a propensity analysis.
RESULTS:Of 785 consecutive HBV carriers between 1998 and 2008, 117 patients who received NA therapy and 117 patients who did not, were selected by eligibility criteria and propensity score matching. Factors associated with the development of HCC were analyzed. In the follow-up period, HCC developed in 57 of 234 patients (24.4%). Factors significantly associated with the incidence of HCC, as determined by Cox proportional hazards models, include higher age (hazard ratio, 4.36 [95% confidence interval, 1.33-14.29], p=0.015), NA treatment (0.28 [0.13-0.62], p=0.002), basal core promoter (BCP) mutations (12.74 [1.74-93.11], p=0.012), high HBV core-related antigen (HBcrAg) (2.77 [1.07-7.17], p=0.036), and high gamma glutamyl transpeptidase levels (2.76 [1.49-5.12], p=0.001).
CONCLUSIONS:NA therapy reduced the risk of HCC compared with untreated controls. Higher serum levels of HBcrAg and BCP mutations are associated with progression to HCC, independent of NA therapy.
背景与目标:
背景与目的:某些慢性乙型肝炎病毒(HBV)感染患者会发展为肝细胞癌(HCC)。然而,尚不清楚核苷酸(t)ide类似物(NA)治疗对肝癌进展的长期影响。
方法:因此,我们使用倾向分析将接受NA治疗的慢性乙型肝炎患者与未接受NA治疗的慢性乙型肝炎患者进行比较。
结果:在1998年至2008年之间的785例连续HBV携带者中,通过资格标准和倾向评分匹配选择了接受NA治疗的117例患者和未接受NA治疗的117例患者。分析了与肝癌发展相关的因素。在随访期间,234例患者中有57例发生了HCC(24.4%)。由Cox比例风险模型确定的与HCC发生率显着相关的因素包括较高的年龄(风险比,4.36 [95%置信区间,1.33-14.29],p = 0.015),NA治疗(0.28 [0.13-0.62]) ,p = 0.002),基础核心启动子(BCP)突变(12.74 [1.74-93.11],p = 0.012),高HBV核心相关抗原(HBcrAg)(2.77 [1.07-7.17],p = 0.036)和高γ-谷氨酰转肽酶水平(2.76 [1.49-5.12],p = 0.001)。
结论:与未治疗的对照组相比,NA治疗降低了HCC的风险。血清HBcrAg和BCP突变水平升高与肝癌进展有关,而与NA治疗无关。