임영석 (울산대학교 의과대학, 서울아산병원) | 한빛사논문 > 한빛사

한빛사논문

조회1,082

울산대학교 의과대학, 서울아산병원

CV File 186 kb

Am. J. Gastroenterol., January 2, 2020 | doi: 10.14309/ajg.0000000000000490 Earlier Alanine Aminotransferase Normalization During Antiviral Treatment Is Independently Associated With Lower Risk of Hepatocellular Carcinoma in Chronic Hepatitis B

Choi, Jonggi MD, PhD¹; Kim, Gi-Ae MD, PhD²; Han, Seungbong PhD³; Lim, Young-Suk MD, PhD^1,*

¹Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;
²Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea;
³ Department of Applied Statistics, Gachon University, Seongnam-si, Gyeonggi-do, Republic of Korea.

^*Correspondence: Young-Suk Lim, MD, PhD.

Abstract

OBJECTIVES:
It was suggested that normalization of serum alanine aminotransferase (ALT) levels at 1 year of antiviral treatment is associated with a lower risk of hepatic events in patients with chronic hepatitis B (CHB). However, it remains unclear whether earlier ALT normalization is associated with lower hepatocellular carcinoma (HCC) risk, independent of fatty liver or cirrhosis and on-treatment virological response (VR), in patients with CHB.

METHODS:
We analyzed 4,639 patients with CHB who initiated treatment with entecavir or tenofovir using landmark analysis and time-dependent Cox analysis. We defined normal ALT as ≤35 U/L (men) and ≤25 U/L (women) and VR as serum hepatitis B virus DNA <15 IU/mL.

RESULTS:
During a median 5.6 years of treatment, 509 (11.0%) patients developed HCC. ALT normalization occurred in 65.6% at 1 year and 81.9% at 2 years and was associated with a significantly lower HCC risk in landmark (P < 0.001) and time-dependent Cox analyses (adjusted hazard ratio [AHR] 0.57; P < 0.001). Compared with ALT normalization within 6 months, delayed ALT normalization at 6–12, 12–24, and >24 months was associated with incrementally increasing HCC risk (AHR 1.40, 1.74, and 2.45, respectively; P < 0.001), regardless of fatty liver or cirrhosis at baseline and VR during treatment. By contrast, neither earlier VR (AHR 0.93; P = 0.53) nor earlier hepatitis B e antigen seroclearance (AHR 0.91; P = 0.31) was associated with a significantly lower HCC risk.

DISCUSSION:
In patients with CHB treated with entecavir or tenofovir, earlier ALT normalization was independently associated with proportionally lower HCC risk, regardless of fatty liver or cirrhosis at baseline and on-treatment VR.

논문정보

형식Research article
게재일2020년 01월 (BRIC 등록일 2020-01-08)
연구진국내 연구진
분야 의약학 > 응용의학

댓글 작성 로그인

CV 열람하기

연락처 보기