香港中文大学:如何降低慢性乙肝患者患肝癌风险?
创作:爱的抉择 审核:Lexi 2019年10月28日
  • 恩替卡韦和替诺福韦(TDF)均能治疗慢性HBV感染,但其与肝癌发生风险间的关系存在争议;
  • 2008年1月-2018年6月,随访29350名慢性HBV感染患者,其中1309人接受TDF,28041人接受恩替卡韦治疗,中位随访期为3.6年;
  • TDF组年龄更小(43.2岁 vs 53.4岁),肝硬化比例更低(2.9% vs 13.6%);
  • TDF组和恩替卡韦组肝癌发生率分别为0.6%和4.9%;
  • 经统计分析,相比于接受恩替卡韦治疗,接受TDF治疗与降低中国慢性HBV感染患者的肝癌风险相关。
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Lexi
慢性乙型肝炎(CHB)是肝细胞癌(HCC)、肝硬化并发症、肝脏相关死亡的主要病因之一。对慢性乙型肝炎病毒(HBV)感染患者治疗的主要目标是降低其向肝硬化、肝脏相关死亡(包括HCC)发展的风险。目前,恩替卡韦和替诺福韦的两种前药,包括富马酸替诺福韦二吡酯(TDF)和替诺福韦阿拉福胺(TAF),被推荐为CHB患者一线的核酸类似物(NA)治疗。然而,用替诺福韦(TDF)或恩替卡韦治疗HBV感染患者,其患HCC风险的研究结果相互矛盾。来自香港中文大学威尔斯亲王医院的Grace Lai-Hung Wong团队比较了TDF与恩替卡韦对中国慢性HBV感染患者患HCC风险的影响。该研究共纳入29350名接受恩替卡韦或TDF治疗的CHB患者,使用倾向评分加权和1:5匹配来平衡两组之间的临床特征。结果证明在中位3.6年的随访中,与恩替卡韦治疗相比,接受TDF治疗与降低中国慢性HBV感染患者的肝癌风险相关。
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Gastroenterology [IF:22.682]

Tenofovir is Associated With Lower Risk of Hepatocellular Carcinoma Than Entecavir in Patients With Chronic HBV Infection in China

与恩替卡韦相比,替诺福韦与中国慢性乙型肝炎病毒(HBV)感染患者更低的肝细胞癌风险相关

10.1053/j.gastro.2019.09.025

2019-09-28, Article

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Background & Aims: There have been conflicting results from studies comparing the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection treated with tenofovir disoproxil fumarate (TDF) vs those treated with entecavir. We compared the effects of TDF vs entecavir on HCC risk in a large cohort of patients with chronic HBV infection in China.
Methods: We performed a retrospective study of consecutive adults with chronic HBV infection who initially received treatment with entecavir or TDF, for at least 6 months, from January 2008 through June 2018. Patients who had cancers or liver transplantation before or within the first 6 months of treatment were excluded. Propensity score weighting and 1:5 matching were used to balance the clinical characteristics between the 2 groups. Fine-Gray model was used to adjust for competing risk of death and liver transplantation.
Results: We analyzed data from 29,350 patients (mean age, 52.9±13.2 years; 18,685 male (63.7%); 1309 were first treated with TDF (4.5%) and 28,041 were first treated with entecavir (95.5%). TDF-treated patients were younger (mean age, 43.2 years vs 53.4 years) and a lower proportion had cirrhosis (38 patients [2.9%] vs 3822 patients treated with entecavir [13.6%]). At a median follow-up time of 3.6 years after treatment began (inter-quartile range, 1.7–5.0 years), 8 TDF-treated patients (0.6%) and 1386 entecavir-treated patients (4.9%) developed HCC. Patients’ clinical characteristics were comparable after propensity score weighting. TDF treatment was associated with a lower risk of HCC than entecavir treatment after propensity score weighting (weighted subdistribution hazard ratio, 0.36, 95% CI, 0.16–0.80; P=.013) and 1:5 matching (weighted subdistribution hazard ratio, 0.39, 95% CI, 0.18–0.84; P=.016).
Conclusions: In a retrospective analysis of 29,350 patients with chronic HBV infection in China, treatment with TDF was associated with a lower risk of HCC than treatment with entecavir, over a median follow-up time of 3.6 years.

First Authors:
Terry Cheuk-Fung Yip

Correspondence Authors:
Grace Lai-Hung Wong

All Authors:
Terry Cheuk-Fung Yip,Vincent Wai-Sun Wong,Henry Lik-Yuen Chan,Yee-Kit Tse,Grace Chung-Yan Lui,Grace Lai-Hung Wong

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