肝细胞癌发生率和C型肝炎患者的危险因素:干扰素与直接作用剂对比
Yu-Ting Kao1,2, Yen-Chun Liu1,2, Ya-Ting Cheng1,2
1Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan.
Viruses
|September 28, 2024
概括
对型肝炎病毒 (HCV) 的直接作用抗病毒 (DAA) 治疗显示出较高的初始肝细胞癌 (HCC) 风险,特别是在晚期肝病患者中. 然而,HCC风险在三年后下降,这表明需要量身定制的监测.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 病毒学 病毒学
- 在瘤学瘤学.
背景情况:
- 肝细胞癌 (HCC) 是慢性型肝炎 (HCV) 患者的一个主要问题,即使在持续的病毒学反应 (SVR) 后.
- 直接作用抗病毒药物 (DAA) 和基于干扰素 (IFN) 的疗法用于实现SVR,但它们对HCC风险的比较影响至关重要.
研究的目的:
- 为了比较患有慢性型肝炎 (HCV) 患者患肝细胞癌 (HCC) 的风险,这些患者使用直接作用抗病毒药物 (DAA) 与干扰素 (IFN) 疗法实现了持续的病毒学反应 (SVR).
主要方法:
- 追溯分析4806名没有共感染或之前HCC病史的HCV患者.
- 使用Kaplan-Meier和Cox回归分析与倾向分数匹配 (PSM) 来调整基线差异.
主要成果:
- 与IFN治疗患者相比,DAA治疗的患者在SVR后的HCC发病率更高 (6年发病率:6%对比3%,p=0.01).
- 在DAA和IFN组治疗后三年后,HCC发病率下降.
- 在接受DAA治疗的晚期肝硬化 (ACLD) 患者中,HCC发病率在前三年较高,但随后下降.
结论:
- 直接作用抗病毒药物 (DAA) 治疗影响HCC风险,特别是在治疗后的前三年内,特别是在患有ACLD的年轻HCV患者中.
- 虽然在DAA治疗的ACLD患者中,HCC发病率在三年后减少,但持续监测仍然至关重要.
- 60岁以下没有晚期肝病的患者可能需要在DAA治疗后进行不那么密集的随访.
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