HBcrAg或能预测肝细胞癌（HCC）的发展
近期研究表明HBV核心相关抗原（HBcrAg）能预测初次接受核苷（酸）类似物治疗的慢性HBV感染者肝细胞癌（HCC）的发展。日本大恒市医院研究团队称“HBcrAg能更好地预测HCC发展与HBV DNA相比。”
但是研究者同时认为需要进行前瞻性以社区为单位的未接受核苷（酸）类似物治疗的患者的队列研究，而加以确定。
在平均10.7年的随访时间内，1031例慢性HBV感染者中78例诊断为HCC。HCC的5年，10年，15年，20年的累积发病率分别为2.0%，8.3%，10.7%，12.5%。
将与病毒相关标记纳入多变量分析（比如HBV 基因型、HBV DNA水平），发现HBcrAg>2.9logU/mL能够预测HCC的发展（风险比HR=5.05，P<0.001）。其他与HCC发展明显相关的预测因素是基本核心启动子突变（风险比HR=28.85，P<0.001）。
出现HBcrAg>2.9logU/mL和基本核心启动子突变患者，HCC5年及20年的累积发病率为6.4%，34.4%，明显高于野生型的HBcrAg小于等于临界值的同种患者，后者所有时间点的HCC累积发病率为0.0%（P<0.001）。
各时间点HBcrAg预测HCC发病率的精确度高于HBV DNA，比如二者在2年和10年预测HCC发病率分别为80% vs 75% ， 70% vs 65% 。
作者在肝脏病学杂志上总结“慢性HBV感染者中高水平的HBcrAg可预测HCC发生，并且HBcrAg也是HCC发展的良好预测因素。”
英文原文
HBcrAg may predict HCC development
Research suggests a role for hepatitis B core-related antigen (HBcrAg) in the prediction of hepatocellular carcinoma (HCC) development in nucleos(t)ide analogue treatment-naïve patients with chronic hepatitis B virus (HBV) infection.
Researcher Toshifumi Tada (Ogaki Municipal Hospital, Japan) and team say that HBcrAg is "superior to HBV DNA [- a previously reported HCC risk predictor -] in terms of predictive power for HCC development."
But they stress the need for further prospective studies in community-based cohorts and patients who have received nucleos(t)ide analogue therapy.
During a median follow-up of 10.7 years, 78 of 1031 chronic HBV patients included in this medical review were diagnosed with HCC. The cumulative incidence rate of HCC was 2.0% at 5 years, rising to 8.3%, 10.7% and 12.5% at 10, 15 and 20 years, respectively.
Multivariate analysis taking into account various virus-related markers, such as HBV genotype and HBV DNA levels, showed that HBcrAg levels over 2.9 log U/mL predicted HCC development with a significant hazard ratio (HR) of 5.05 (p<0.001). The only other factor significantly associated with HCC progression was the presence of basal core promoter mutations (HR=28.85; p<0.001).
The cumulative incidence of HCC among patients with HBcrAg levels above 2.9 log U/mL and a basal core promoter mutation ranged from 6.4% at 5 years to 34.4% at 20 years, significantly higher than among their wild-type counterparts with HBcrAg levels at or below the cutoff, in whom it was 0.0% at all timepoints (p<0.001).
The accuracy of HBcrAg to predict HCC incidence, as estimated by time-dependant receiver operating characteristic analysis, was higher than for HBV DNA at all timepoints, at, for instance, 80% versus 75% at 2 years and 70% versus 65% at 10 years.
The authors conclude in the Journal of Hepatology that the "levation of HBcrAg levels in patients is associated with the development of HCC", adding that in their view "HBcrAg is an excellent predictor" of progression to HCC.
Licensed from medwireNews with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.
来源：艾兰博曼医学网
页:
[1]