PDF下载 ( 459 KB)
Effect of entecavir antiviral therapy alone or combined with interferon on the risk of hepatocellular carcinoma in patients with chronic hepatitis B
-
摘要:
目的探究恩替卡韦（ETV）联合干扰素（IFN）治疗与ETV单药治疗对慢性乙型肝炎相关肝细胞癌（HCC）发生的影响。方法回顾性选取2008年1月-2014年12月在北京地坛医院收治的409例慢性乙型肝炎患者,根据抗病毒治疗方式不同分为联合IFN组（n=169,IFN治疗≥6个月）及ETV单药组（n=240,ETV治疗≥12个月）,随访截止至2019年6月,以观察对象发生HCC为终点事件。连续变量两组间比较采用Mann-Whitney U检验,分类变量两组间比较采用χ2检验。倾向评分匹配法（PSM）消除组间基线差异,Kaplan-Meier法及log-rank检验用于比较组间的HCC发生率,Cox比例风险回归模型分析影响HCC发生的危险因素。结果研究中位随访时间为5.4（4.9～7.9）年。联合IFN组HCC累积发病率与ETV单药组相比,匹配前后差异均无统计学意义（PSM前:1.2%vs 2.8%,χ2=1.423,P=0.233; PSM后:1.7%vs 4.1%,χ2=1.676,P=0.195）;亚组分析表明,在非高风险患癌人群中两组HCC累积发病率也无明显差异（1.3%vs 1.5...
Abstract:Objective To investigate the effect of entecavir( ETV) alone or combined with interferon( IFN) on the risk of hepatocellular carcinoma( HCC) in patients with chronic hepatitis B( CHB). Methods A retrospective analysis was performed for 409 patients with CHB who were admitted to Beijing Ditan Hospital from January 2008 to December 2014,and according to their antiviral therapy,they were divided into ETV + IFN group with 169 patients( IFN treatment for ≥6 months) and ETV group with 240 patients( ETV treatment for ≥12 months). The patients were followed up to June 2019,and the development of HCC was the outcome event. The Mann-Whitney U test was used for comparison of continuous variables between two groups,and the chi-square test was used for comparison of categorical variables between two groups. The propensity score matching( PSM) method was used to eliminate baseline differences between groups,the Kaplan-Meier method and the log-rank test were used to compare the incidence rate of HCC between groups,and the Cox proportional-hazards regression model analysis was used to investigate the risk factors for the development of HCC. Results The median follow-up time in this study was 5. 4 years( IQR: 4. 9-7. 9). There was no significant difference in the cumulative incidence rate of HCC between the two groups before and after PSM( before PSM: 1. 2% vs 2. 8%,χ2= 1. 423,P = 0. 233; after PSM: 1. 7% vs 4. 1%,χ2= 1. 676,P = 0. 195),and the subgroup analysis also showed no significant difference in the cumulative incidence rate of HCC between the two groups in the non-high risk population( 1. 3% vs 1. 5%,χ2= 0. 335,P = 0. 563). The Cox proportional-hazards regression model showed that age was an independent risk factor for HCC( hazard ratio = 1. 107,95% confidence interval: 1. 005-1. 219,P = 0. 038). Conclusion For CHB patients without a high risk of cancer,compared with ETV monotherapy,ETV combined with IFN for at least 6 months does not significantly reduce the risk of HCC.
-
Key words:
- hepatitis B,chronic /
- carcinoma,hepatocellular /
- interferons /
- entecavir /
- comparative study
-
[1] RAN JC,WANG L,ZHANG Y,et al. Disability adjusted life years for liver cancer in China:Trend analysis from 1990 to2016 and future prediction[J]. Chin J Evid-based Med,2018,18(5):11-19.(in Chinese)冉建朝，王乐，张玥，等．中国人群肝癌所致DALYs疾病负担:1990~2016年长期分析及预测[J]．中国循证医学杂志，2018,18(5):11-19. [2] TORRE LA,BRAY F,SIEGEL RL,et al. Global cancer statistics,2012[J]. CA Cancer J Clin,2015,65(2):87-108. [3] BEDOSSA P. Reversibility of hepatitis B virus cirrhosis after therapy:Who and why?[J]. Liver Int,2015,35(Suppl 1):78-81. [4] LIANG KH,HSU CW,CHANG ML,et al. Peginterferon is superior to nucleos(t)ide analogues for prevention of hepatocellular carcinoma in chronic hepatitis B[J]. J Infect Dis,2015,213(6):966-974. [5] REN P,CAO Z,MO R,et al. Interferon-based treatment is superior to nucleos(t)ide analog in reducing HBV-related hepatocellular carcinoma for chronic hepatitis B patients at high risk[J]. Expert Opin Biol Ther,2018,18(10):1085-1094. [6] LI SY,LI H,XIONG YL,et al. Peginterferon is preferable to entecavir for prevention of unfavourable events in patients with HBeAg-positive chronic hepatitis B:A five-year observational cohort study[J]. J Viral Hepat,2017,24(Suppl 1):12-20. [7] KIM JH,KIM YD,LEE M,et al. Modified PAGE-B score predicts the risk of hepatocellular carcinoma in Asians with chronic hepatitis B on antiviral therapy[J]. J Hepatol,2018,69(5):1066-1073. [8] Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J]. J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会，中华医学会感染病学分会．慢性乙型肝炎防治指南(2015年更新版)[J]．临床肝胆病杂志，2015,31(12):1941-1960. [9] National Health and Family Planning Commission of the People’s Republic of China. Diagnosis,management,and treatment of hepatocellular carcinoma(V2017)[J]. J Clin Hepatol,2017,33(8):1419-1431.(in Chinese)中华人民共和国国家卫生和计划生育委员会．原发性肝癌诊疗规范(2017年版)[J]．临床肝胆病杂志，2017,33(8):1419-1431. [10] ZHANG W,WANG X,WANG Y,et al. Effective viral suppression is necessary to reduce hepatocellular carcinoma development in cirrhotic patients with chronic hepatitisB:Results of a10-year follow up[J]. Medicine,2017,96(44):e8454-e8489. [11] YUAN G,HU AR,HU YR,et al. Clinical efficacy and longterm prognosis of entecavir and adefovir dipivoxil in the treatment of compensatory hepatitis B cirrhosis[J]. Chin J Clin Pharmacol Ther,2018,23(2):170-174.(in Chinese)袁刚，胡爱荣，胡耀仁，等．恩替卡韦和阿德福韦酯治疗代偿期乙肝肝硬化临床疗效及远期预后[J]．中国临床药理学与治疗学，2018,23(2):170-174. [12] ZHANG S,WANG YX,SUN J,et al. Effect of antiviral therapy combined with interferon on negative conversion rate of surface antigen among patients of chronic hepatitis B treated with nucleos(t)ide analogues[J/CD]. Chin J Exp Clin Infect Dis(Electronic Version),2019,13(4):273-280.(in Chinese)张珊，王艺璇，孙静，等．干扰素联合抗病毒治疗对提高核苷(酸)类药物经治慢性乙型肝炎患者表面抗原阴转率的影响[J/CD]．中华实验和临床感染病杂志(电子版)，2019,13(4):273-280. 期刊类型引用(3)
1. 刘晓，李涛，李崇国，吴达军，肖苓，吕家华. 原发性肝癌立体定向放疗的疗效及安全性研究. 肿瘤预防与治疗. 2021(06): 493-501 . 
百度学术2. 陈明东，王凯，吴彬，吴燕斌. 简易腹压装置限制呼吸运动对肝癌放射治疗摆位误差的影响. 基层医学论坛. 2021(23): 3339-3341 . 百度学术3. 杨曌，谢辉，王权，张弢，王华明，何卫平，段学章. 射波刀与射频消融治疗小肝癌的近期效果比较. 临床肝胆病杂志. 2019(09): 1965-1969 . 
本站查看其他类型引用(4)
-
百度学术
下载:
