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면역 관용기 만성 B형간염 환자의 간세포암 및 사망 발생의 위험성

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Abstract
Objective: High serum hepatitis B virus (HBV) DNA levels are associated with high risks of hepatocellular carcinoma (HCC) and cirrhosis in chronic hepatitis B (CHB) patients. Although the immune-tolerant (IT) phase is characterized by high circulating HBV DNA levels, it remains unknown whether antiviral treatment reduces risks of HCC and mortality.
Design: This historical cohort study included HBeAg-positive CHB patients with high HBV DNA levels (≥20,000 IU/mL) and no evidence of cirrhosis at a tertiary referral hospital in Korea from 2000 to 2013. The clinical outcomes of 413 untreated IT phase patients with normal alanine aminotransferase (ALT) levels (females, <19 IU/mL; males, <30 IU/mL) were compared with those of 1497 immune-active (IA) phase patients (ALT ≥80 IU/mL) treated with nucleos(t)ide analogs.
Results: The IT group was significantly younger than the IA group (mean age, 38 vs 40 years at baseline, p=0.04). The 10-year estimated cumulative incidences of HCC (12.7% vs 6.1%; p=0.001) and death/transplantation (9.7% vs 3.4%; p <0.001) were significantly higher in the IT group than the IA group. In multivariable analyses, the IT group showed a significantly higher risk of HCC (hazard ratio [HR], 2.54; 95% confidence interval [CI], 1.54-4.18) and death/transplantation (HR, 3.38; 95% CI, 1.85-6.16) than the IA group; which was consistently identified through inverse probability treatment weighting, propensity score-matched, and competing risks analyses.
Conclusions: Untreated IT phase CHB patients had higher risks of HCC and death/transplantation than treated IA phase patients. Unnecessary deaths could be prevented through earlier antiviral intervention in select IT phase patients.
Author(s)
김기애
Issued Date
2017
Awarded Date
2018-02
Type
Dissertation
Keyword
Antiviral treatmentHBeAg-positiveHepatocellular carcinomaImmune-active phaseMortality
URI
https://oak.ulsan.ac.kr/handle/2021.oak/6675
http://ulsan.dcollection.net/common/orgView/200000003197
Alternative Author(s)
Kim Gi-Ae
Affiliation
울산대학교
Department
일반대학원 의학과
Advisor
임영석
Degree
Doctor
Publisher
울산대학교 일반대학원 의학과
Language
eng
Rights
울산대학교 논문은 저작권에 의해 보호받습니다.
Appears in Collections:
Medicine > 2. Theses (Ph.D)
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