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慢性乙型肝炎患者抗病毒治疗过程中发生肝癌的风险预测模型
DOI: 10.3969/j.issn.1001-5256.2021.02.039
作者贡献声明：向慧玲负责课题设计，拟定写作思路；徐佰国负责文献资料查阅及分析撰写论文；韩涛负责修改论文，指导撰写文章并最后定稿。
Advances in the models for predicting the risk of liver cancer during antiviral therapy in patients with chronic hepatitis B
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摘要: HBV感染是肝硬化和肝癌的主要病因之一。抗病毒药物的使用明显降低了慢性乙型肝炎患者肝癌的发生风险，但部分长期服用抗病毒药物患者，最终仍发生肝癌。因此，有必要对此类患者发生肝癌的风险进行早期识别和预测。当前根据肝硬化、年龄、性别、肝硬度、病毒学、血清学指标、饮酒情况、糖尿病病史等危险因素，形成了一些慢性乙型肝炎患者抗病毒治疗过程中发生肝癌的风险预测模型，这些预测模型包括mREACH-B、PAGE-B、mPAGE-B、APA-B、CAMD、AASL、REAL-B等。综述了慢性乙型肝炎患者抗病毒治疗过程中发生肝癌的风险预测模型研究进展。Abstract: Hepatitis B virus infection is one of the primary causes of liver cirrhosis and liver cancer. The use of antiviral drugs significantly reduces the risk of liver cancer in patients with chronic hepatitis B (CHB), but some of the patients who receive antiviral drugs for a long time still develop liver cancer. Therefore, it is necessary to early identify and predict the risk of liver cancer in such patients. Currently, several models for predicting the risk of liver cancer during antiviral therapy in CHB patients have been developed based on the risk factors such as liver cirrhosis, age, sex, liver stiffness, virology, serological markers, alcohol consumption, and history of diabetes, including REACH-B, PAGE-B, mPAGE-B, APA-B, CAMD, AASL, and REAL-B. This article reviews the research advances in the models for predicting the risk of liver cancer during antiviral therapy in CHB patients.
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Key words:
- Hepatitis B, Chronic /
- Liver Neoplasms /
- Risk Factors
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表 1 CHB患者口服抗病毒治疗过程中发生肝癌的风险预测模型简表
预测模型 作者 发表年限 国家及地区 纳入人群 入组标准 预测因素 HCC预测效能 是否外部验证 mREACH-B Jung等[19] 2015 韩国 接受抗病毒治疗848例未接受抗病毒治疗460例 CHB患者或肝功能Child-Pugh A级患者(包括曾经、正在、未抗病毒患者) 年龄、性别、ALT、HBeAg状态、肝硬度 3、5年AUC为0.813、0.795(抗病毒人群) 否 PAGE-B Papatheodoridis等[20] 2016 希腊 推导组1325例验证组490例 接受ETV和/或TDF治疗≥1年的CHB患者 年龄、性别、血小板计数 第5年C指数为0.82、0.82 (推导队列、验证队列) 是 mPAGE-B Kim等[21] 2018 韩国 推导组2001例验证组1000例 接受ETV或TDF治疗≥1年的CHB患者 年龄、性别、血小板计数、白蛋白 5年AUC为0.82、0.82(推导队列、验证队列) 否 APA-B Chen等[22] 2017 中国台湾 推导组883例验证组442例 ETV治疗12个月以上初治CHB患者 年龄、血小板计数、治疗12个月后AFP水平 2、3、5年AUC为0.939、0.892、0.862(验证队列) 否 CAMD Hsu等[23] 2018 中国台湾 推导组23 851例验证组19 321例 接受ETV或TDF治疗的CHB患者 肝硬化、年龄、男性和糖尿病 第1、2、3年C指数为0.74、0.75、0.75(验证队列) 是 AASL-HCC Yu等[24] 2019 韩国 推导组944例验证组298例 首次接受ETV或TDF治疗CHB患者 年龄、白蛋白、性别、肝硬化 第5年C指数为0.802、0.805(推导队列、验证队列) 是 REAL-B Yang等[25] 2019 中国台湾 推导组5365例验证组2683例 接受口服抗病毒药物治疗的亚洲CHB(包括亚裔美国人和本土亚洲人) 性别、年龄、酒精摄入量、糖尿病、基线是否肝硬化、血小板计数、AFP 第3、5、10年AUC为0.83、0.81、0.81(验证队列) 否 
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