HBcrAg或能预测肝细胞癌（HCC）的发展

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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 "[e]levation of HBcrAg levels in [chronic HBV] patients is associated with the development of HCC", adding that in their view "HBcrAg is an excellent predictor" of progression to HCC.

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来源：艾兰博曼医学网