J Gastroenterol:慢性乙肝患者体内残留的HBV DNA和pgRNA可使肝癌风险增加2-5倍!

2021-03-30 MedSci原创 MedSci原创

HBV DNA或pgRNA与HCC的发生有关

乙型肝炎病毒(HBV)是慢性乙肝肝炎(CHB)患者发展成肝细胞癌(HCC)的一个重要风险因素。2016年,全球约有88万例HBV相关HCC导致的死亡

在过去20年里,有效的核苷酸类似物(即逆转录酶抑制剂[NRTI])的使用显著改变了CHB的病程。但是,仍未完全消除肝脏相关并发症的风险,特别是HCC。

本研究旨在评估NRTI治疗后残留的HBV病毒血症是否与HCC的发生有关。

对104例采用恩替卡韦(ETV)治疗了至少3年、且采用Cobas Taqman法V2.0(罗氏诊断,定量下限[LLOQ]为20IU/mL)检测不到HBV DNA的患者(HCC和非HCC各52例[年龄、性别、肝硬化和疗程相匹配])进行病例对照研究。用高灵敏度半定量PCR检测HCC确诊前1年、1~2年和>2年的血清HBV DNA和前基因组(pg)RNA(检测下限和LLOQ分别为10 IU/mL和51.5 IU/mL)。

确诊HCC时HBV DNA的检出情况

在这104例患者(男性 80.8%、中位年龄 61.2岁、肝硬化 38.5%、中位病程 45.5个月)中,在确诊HCC或随访过程中,38.5%的HCC患者未检出血清DNA,9.6%的HCC患者未检出pgRNA,而非HCC患者分别为65.4%和36.5%(P=0.005和0.001)

确诊HCC时HBV pgRNA的检出情况

可检测到HBV DNA和pgRNA与HCC发生的2年风险升高相关(风险比[HR]分别为2.79和4.544)。HCC患者与非HCC患者的qHBsAg水平无明显差异无。

综上,在标准方法检测的HBV DNA低于LLOQ的CHB患者中,用一种更灵敏的方法进行检测,发现有高达50%以上的患者存在持续性病毒血症。此外,用更灵敏的方法检测到的HBV DNA或pgRNA与HCC的发生有关。因此,临床上需要采用更有效的病毒抑制和更灵敏的检测方法来进一步降低肝癌的风险。

原始出处:

Mak Lung-Yi,Huang Qi,Wong Danny Ka-Ho et al. Residual HBV DNA and pgRNA viraemia is associated with hepatocellular carcinoma in chronic hepatitis B patients on antiviral therapy. J Gastroenterol, 2021, https://doi.org/10.1007/s00535-021-01780-5

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encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Sat Nov 27 05:39:09 CST 2021, time=2021-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1836703, encodeId=b2f81836e03ee, content=<a href='/topic/show?id=f9d08524be' target=_blank style='color:#2F92EE;'>#HBV#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8524, encryptionId=f9d08524be, topicName=HBV)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e87531, createdName=klivis, createdTime=Fri Feb 11 19:39:09 CST 2022, time=2022-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1671783, encodeId=8d4b16e178368, content=<a href='/topic/show?id=0bcc2342943' target=_blank style='color:#2F92EE;'>#乙肝患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23429, encryptionId=0bcc2342943, topicName=乙肝患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fc1826842253, createdName=sjzlzc016, createdTime=Tue Mar 30 19:39:09 CST 2021, time=2021-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615324, encodeId=9a4416153240a, content=<a href='/topic/show?id=29ae826375' target=_blank style='color:#2F92EE;'>#GRN#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8263, encryptionId=29ae826375, topicName=GRN)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f68619606350, createdName=ms7517674339485982, createdTime=Thu Apr 01 01:39:09 CST 2021, time=2021-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=952548, encodeId=62c9952548eb, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/20/44e485222679b3a7b0d5676ca7443126.jpg, createdBy=ef735089224, createdName=随风1991, createdTime=Wed Mar 31 07:39:47 CST 2021, time=2021-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1040374, encodeId=33ee10403e4bf, content=肝癌,接下来就要细分了,对于体质好的病人,能否将PD-1类+抗血管新生+放疗等相结合,甚至有必要用TACE进行减负, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=留走人康, createdTime=Tue Mar 30 13:39:09 CST 2021, time=2021-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=952339, encodeId=523495233923, content=更新认知,谢谢!, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=46905128057, createdName=zy&kt, createdTime=Tue Mar 30 11:40:00 CST 2021, time=2021-03-30, status=1, ipAttribution=)]
  5. 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encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Sat Nov 27 05:39:09 CST 2021, time=2021-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1836703, encodeId=b2f81836e03ee, content=<a href='/topic/show?id=f9d08524be' target=_blank style='color:#2F92EE;'>#HBV#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8524, encryptionId=f9d08524be, topicName=HBV)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e87531, createdName=klivis, createdTime=Fri Feb 11 19:39:09 CST 2022, time=2022-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1671783, encodeId=8d4b16e178368, content=<a href='/topic/show?id=0bcc2342943' target=_blank style='color:#2F92EE;'>#乙肝患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23429, encryptionId=0bcc2342943, topicName=乙肝患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fc1826842253, createdName=sjzlzc016, createdTime=Tue Mar 30 19:39:09 CST 2021, time=2021-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615324, encodeId=9a4416153240a, content=<a href='/topic/show?id=29ae826375' target=_blank style='color:#2F92EE;'>#GRN#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8263, encryptionId=29ae826375, topicName=GRN)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f68619606350, createdName=ms7517674339485982, createdTime=Thu Apr 01 01:39:09 CST 2021, time=2021-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=952548, encodeId=62c9952548eb, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/20/44e485222679b3a7b0d5676ca7443126.jpg, createdBy=ef735089224, createdName=随风1991, createdTime=Wed Mar 31 07:39:47 CST 2021, time=2021-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1040374, encodeId=33ee10403e4bf, content=肝癌,接下来就要细分了,对于体质好的病人,能否将PD-1类+抗血管新生+放疗等相结合,甚至有必要用TACE进行减负, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=留走人康, createdTime=Tue Mar 30 13:39:09 CST 2021, time=2021-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=952339, encodeId=523495233923, content=更新认知,谢谢!, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=46905128057, createdName=zy&kt, createdTime=Tue Mar 30 11:40:00 CST 2021, time=2021-03-30, status=1, ipAttribution=)]
    2022-02-11 klivis
  6. 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content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/20/44e485222679b3a7b0d5676ca7443126.jpg, createdBy=ef735089224, createdName=随风1991, createdTime=Wed Mar 31 07:39:47 CST 2021, time=2021-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1040374, encodeId=33ee10403e4bf, content=肝癌,接下来就要细分了,对于体质好的病人,能否将PD-1类+抗血管新生+放疗等相结合,甚至有必要用TACE进行减负, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=留走人康, createdTime=Tue Mar 30 13:39:09 CST 2021, time=2021-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=952339, encodeId=523495233923, content=更新认知,谢谢!, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=46905128057, createdName=zy&kt, createdTime=Tue Mar 30 11:40:00 CST 2021, time=2021-03-30, status=1, ipAttribution=)]
  7. 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  8. [GetPortalCommentsPageByObjectIdResponse(id=2073287, encodeId=bc3220e3287c6, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Tue Nov 16 22:39:09 CST 2021, time=2021-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2061999, encodeId=1123206199991, content=<a href='/topic/show?id=e6e1e15509f' target=_blank style='color:#2F92EE;'>#癌风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71550, encryptionId=e6e1e15509f, topicName=癌风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, 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objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=46905128057, createdName=zy&kt, createdTime=Tue Mar 30 11:40:00 CST 2021, time=2021-03-30, status=1, ipAttribution=)]
    2021-03-31 随风1991

    学习了

    0

  9. 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objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=46905128057, createdName=zy&kt, createdTime=Tue Mar 30 11:40:00 CST 2021, time=2021-03-30, status=1, ipAttribution=)]
    2021-03-30 留走人康

    肝癌,接下来就要细分了,对于体质好的病人,能否将PD-1类+抗血管新生+放疗等相结合,甚至有必要用TACE进行减负

    0

  10. 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objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=46905128057, createdName=zy&kt, createdTime=Tue Mar 30 11:40:00 CST 2021, time=2021-03-30, status=1, ipAttribution=)]
    2021-03-30 zy&kt

    更新认知,谢谢!

    0

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