Effect of low-level viremia on the incidence of hepatocellular carcinomas in patients with hepatitis B cirrhosis treated with entecavir

doi:10.3969/j.issn.1004-583X.2024.11.003

Abstract

Abstract:

Objective To investigate the effect of low-level viremia (LLV) on the incidence of hepatocellular carcinomas (HCC) in patients with hepatitis B cirrhosis treated with entecavir. Methods A total of 140 patients with hepatitis B cirrhosis admitted from January 2017 to December 2017 and treated with entecavir for more than one year were selected and followed up for five years. According to hepatitis B virus (HBV) DNA detection, patients were divided into LLV group (68 cases) and maintained virological response (MVR) group (72 cases). Factors influencing LLV were observed, and the incidence and mortality of HCC within five years were compared between groups. Results There were significant differences between LLV group and MVR group in age, baseline hepatitis B e antigen (HBeAg) (positive), HBV DNA level and hepatitis B surface antigen (HBsAg) titer before treatment (P<0.05), but no significant differences in gender, body mass index (BMI), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (P>0.05). Binary Logistic regression showed that baseline HBeAg (positive), HBV DNA level and HBsAg titer before treatment were influencing factors for LLV (P<0.05). After five years of follow-up, the incidence of HCC was significantly higher in the LLV group than that of MVR group (23.5% vs 9.7%, P<0.05). The mortality of patients diagnosed with HCC in LLV group was comparable to that of MVR group (43.8% vs 42.8%, P>0.05). Conclusion LLV increases the risk of HCC. Patients with hepatitis B cirrhosis treated with entecavir should be highly concerned, and effective treatment should be adopted to transform LLV into a complete viral response and reduce adverse clinical effects.

Key words: liver cirrhosis, entecavir, low-level viremia, hepatocellular carcinoma

CLC Number:

R575.2

Zhang Shasha, Zhao Yingchun, Zhou Hongxia. Effect of low-level viremia on the incidence of hepatocellular carcinomas in patients with hepatitis B cirrhosis treated with entecavir[J]. Clinical Focus, 2024, 39(11): 980-983.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.11.003

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I11/980

Figures/Tables 3

Tab.1 General data between LLV group and MVR group

组别	例数	性别[例(%)]		年龄 (岁)	BMI (kg/m²)	ALT (U/L)	AST (U/L)	HBeAg(阳性) [例(%)]	HBV DNA (log₁₀IU/ml)	HBsAg (log₁₀IU/ml)
组别	例数	男	女	年龄 (岁)	BMI (kg/m²)	ALT (U/L)	AST (U/L)	HBeAg(阳性) [例(%)]	HBV DNA (log₁₀IU/ml)	HBsAg (log₁₀IU/ml)
LLV组	68	39(57.4)	29(42.6)	61.86±6.92	23.93±3.28	53.26±10.87	82.39±16.37	37(54.4)	5.46±0.87	3.07±0.34
MVR组	72	42(58.3)	30(41.7)	58.25±5.38	23.85±3.27	52.87±9.65	83.17±15.92	26(36.1)	4.42±0.69	2.88±0.25
统计值		χ²=0.014		$t$ =2.499	$t$ =0.114	$t$ =0.225	$t$ =0.288	χ²=4.732	$t$ =7.859	$t$ =3.782
P值		0.907		0.014	0.885	0.823	0.776	0.030	0.000	0.000

Tab.1 General data between LLV group and MVR group

组别	例数	性别[例(%)]		年龄 (岁)	BMI (kg/m²)	ALT (U/L)	AST (U/L)	HBeAg(阳性) [例(%)]	HBV DNA (log₁₀IU/ml)	HBsAg (log₁₀IU/ml)
组别	例数	男	女	年龄 (岁)	BMI (kg/m²)	ALT (U/L)	AST (U/L)	HBeAg(阳性) [例(%)]	HBV DNA (log₁₀IU/ml)	HBsAg (log₁₀IU/ml)
LLV组	68	39(57.4)	29(42.6)	61.86±6.92	23.93±3.28	53.26±10.87	82.39±16.37	37(54.4)	5.46±0.87	3.07±0.34
MVR组	72	42(58.3)	30(41.7)	58.25±5.38	23.85±3.27	52.87±9.65	83.17±15.92	26(36.1)	4.42±0.69	2.88±0.25
统计值		χ²=0.014		$t$ =2.499	$t$ =0.114	$t$ =0.225	$t$ =0.288	χ²=4.732	$t$ =7.859	$t$ =3.782
P值		0.907		0.014	0.885	0.823	0.776	0.030	0.000	0.000

Tab.2 Multivariate logistic regression analysis of influencing factors for LLV in patients with hepatitis B cirrhosis treated with entecavir

组别	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
组别	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
年龄	0.001	0.008	0.014	0.864	0.953	0.942	1.015
HBeAg(阳性)	1.197	0.258	18.362	0.000	3.174	2.027	5.139
HBV DNA	0.183	0.064	6.348	0.000	1.197	1.042	1.418
HBsAg	0.794	0.349	22.387	0.000	2.419	1.756	3.387

Tab.3 The incidence and mortality of HCC during 5 years of follow-up

组别	例数	肝癌发生率 [例(%)]	肝癌患者病死率 [例(%)]
LLV组	68	16(23.5)	7(43.8)
MVR组	72	7(9.7)	3(42.8)
统计值		χ²=4.856	χ²=0.002
P值		0.028	0.968

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