医学
肝细胞癌
内科学
乙型肝炎病毒
胃肠病学
危险系数
比例危险模型
乙型肝炎
HBeAg
低风险
慢性肝炎
队列
置信区间
免疫学
乙型肝炎表面抗原
病毒
作者
Gi Ae Kim,Seungbong Han,Gwang Hyeon Choi,Jonggi Choi,Young Suk Lim
摘要
Summary Background Studies have shown a higher risk of hepatocellular carcinoma (HCC) with higher baseline serum hepatitis B virus (HBV) DNA levels in chronic hepatitis B (CHB) patients. However, the association between very high HBV DNA levels (>6 log 10 IU/mL) and HCC risk remains unclear, especially in middle‐aged and old HBeAg‐positive patients. Aim To identify the association between broad‐range HBV DNA levels and HCC risk. Methods We conducted a historical cohort study in Korea involving 6949 non‐cirrhotic, treatment‐naïve CHB patients with alanine aminotransferase (ALT) <2× upper limit of normal for >1 year. HBV DNA was >6 log 10 IU/mL in 2029 (29.2%) patients. Follow‐up was censored when the antiviral therapy was initiated. Results The mean age of the patients was 45 years. During 8.0 years of median follow‐up, 363 patients (5.2%) developed HCC. By multivariable Cox regression analysis, HCC risk was highest with baseline HBV DNA levels of 6‐7 log 10 IU/mL (adjusted hazard ratio [aHR] 4.98; P < 0.001), and lowest with >8 log 10 IU/mL (aHR 0.90; P = 0.71) and ≤4 log 10 IU/mL (aHR 1.00; reference), which was independent of other predictive factors. The similar association between HBV DNA levels and HCC risk was consistently observed in all age subgroups (age <40, 40‐49 and ≥ 50 years). Conclusions HCC risk was highest with moderate serum HBV DNA levels of 6‐7 log 10 IU/mL in CHB patients without significant ALT elevation. Extending treatment indication to CHB patients with moderate levels of HBV DNA may be considered to further prevent HCC, regardless of ALT levels.
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