Perioperative antiviral therapy improves the prognosis of HBV DNA-negative patients with HBV-related hepatocellular carcinoma.
围手术期抗病毒治疗可改善 HBV DNA 阴性的 HBV 相关肝细胞癌患者的预后。
- 作者列表："Li C","Li ZC","Ma L","Li LQ","Zhong JH","Xiang BD","Gong WF
OBJECTIVE:To investigate the effect of perioperative antiviral therapy on the prognosis of hepatitis B virus (HBV) DNA-negative patients with HBV-related hepatocellular carcinoma (HCC). METHODS:The clinical data of 140 patients who were positive for hepatitis B surface antigen (HBsAg) but negative for HBV DNA before partial hepatectomy were retrospectively analyzed. Patients who received perioperaive antiviral therapy were divided into the antiviral therapy group, and those who did not receive any antiviral therapies were divided into the non-antiviral therapy group. Propensity score matching (PSM) was used to match patients 1:1 to eliminate the influence of confounding factors on prognosis. Postoperative liver function, HBV reactivation rate, recurrence-free survival (RFS) and overall survival (OS) were compared between the two groups. After excluding patients with HBV reactivation, the prognostic analysis of the samples was conducted again, and then to observe whether perioperative antiviral therapy was effective for these patients who did not have HBV reactivation after partial hepatectomy. RESULTS:A total of 140 patients were included in this study, including 60 in the antiviral therapy group and 80 in the non-antiviral therapy group. Compared with the non-antiviral therapy group, the antiviral therapy group had a lower rate of HBV reactivation and better postoperative liver function (P < 0.05). The 1-year, 2-year and 3-year survival rates of the antiviral therapy group were better than those of the non-antiviral therapy group before or after PSM (P < 0.05). Prognostic analysis excluding 11 patients with HBV reactivation showed that perioperative antiviral therapy could significantly improve OS (P = 0.004), but had no significant effect on RFS (P = 0.056). Multivariate analyses showed that microvascular invasion (MVI) was the only independent risk factor for tumor recurrence, and antiviral therapy was associated with OS. CONCLUSION:Perioperative antiviral therapy can significantly reduce the risk of HBV reactivation and improve postoperative liver function, and also significantly improve RFS and OS.
目的: 探讨围手术期抗病毒治疗对乙型肝炎病毒 (HBV) DNA 阴性的 HBV 相关性肝细胞癌 (HCC) 患者预后的影响。 方法: 回顾性分析 140 例肝部分切除术前乙肝表面抗原 (HBsAg) 阳性但 HBV DNA 阴性患者的临床资料。将接受围手术期抗病毒治疗的患者分为抗病毒治疗组，未接受任何抗病毒治疗的患者分为非抗病毒治疗组。采用倾向评分匹配 (PSM) 1:1 匹配患者，消除混杂因素对预后的影响。比较两组患者术后肝功能、 HBV 再激动率、无复发生存率 (RFS) 和总生存率 (OS)。排除 HBV 再激活患者后，再次对样本进行预后分析，然后观察围手术期抗病毒治疗对这些肝部分切除术后未发生 HBV 再激活的患者是否有效。 结果: 本研究共纳入 140 例患者，其中抗病毒治疗组 60 例，非抗病毒治疗组 80 例。与未抗病毒治疗组比较，抗病毒治疗组 HBV 再激动率较低，术后肝功能较好 (P <0.05)。PSM 前后抗病毒治疗组 1 、 2 、 3 年生存率均优于非抗病毒治疗组 (P <0.05)。排除 11 例 HBV 再激活患者的预后分析显示，围手术期抗病毒治疗可显著改善 OS (P = 0.004)，但对 RFS 无显著影响 (P = 0.056)。多因素分析显示微血管侵犯 (MVI) 是肿瘤复发的唯一独立危险因素，抗病毒治疗与 OS 相关。 结论: 围手术期抗病毒治疗可显著降低 HBV 再激活风险，改善术后肝功能，同时也显著改善 RFS 和 OS。
METHODS:BACKGROUND:Opioids are often prescribed for pain in cirrhosis and may increase the risk of hepatic encephalopathy (HE). AIMS:To assess the association between opioids and HE in patients with well-compensated cirrhosis. METHODS:We used the IQVIA PharMetrics (Durham, NC) database to identify patients aged 18-64 years with cirrhosis. We excluded patients with any decompensation event from 1 year before cirrhosis diagnosis to 6 months after cirrhosis diagnosis. Over the 6 months after cirrhosis diagnosis, we determined the duration of continuous opioid use and classified use into short term (1-89 days) and chronic (90-180 days). We assessed whether patients developed HE over the subsequent year (ie 6-18 months after cirrhosis diagnosis). We used a landmark analysis and performed multivariable Cox proportional hazards regression to assess associations between opioid use and HE, adjusting for relevant confounders. RESULTS:The cohort included 6451 patients with compensated cirrhosis, of whom 23.3% and 4.7% had short-term and chronic opioid prescriptions respectively. Over the subsequent year, HE occurred in 6.3% patients with chronic opioid prescriptions, 5.0% with short-term opioid prescriptions and 3.3% with no opioid prescriptions. In the multivariable model, an increased risk of HE was observed with short-term (adjusted hazard ratio, HR 1.44, 95% CI 1.07-1.94) and chronic opioid prescriptions (adjusted HR 1.83, 95% CI 1.07-3.12) compared to no opioid prescriptions. CONCLUSION:In this national cohort of privately insured patients with cirrhosis, opioid prescriptions were associated with the risk of incident HE. Opioid use should be minimised in those with cirrhosis and, when required, limited to short duration.
METHODS:BACKGROUND AND AIMS:Cirrhosis is characterized by extensive fibrosis of the liver and is a major cause of liver-related mortality. Cirrhosis is partially heritable but genetic contributions to cirrhosis have not been systemically explored. Here, we carry out association analyses with cirrhosis in two large biobanks and determine the effects of cirrhosis associated variants on multiple human disease/traits. METHODS:We carried out a genome-wide association analysis of cirrhosis as a diagnosis in UK BioBank (UKBB; 1088 cases vs. 407 873 controls) and then tested top-associating loci for replication with cirrhosis in a hospital-based cohort from the Michigan Genomics Initiative (MGI; 875 cases of cirrhosis vs. 30 346 controls). For replicating variants or variants previously associated with cirrhosis that also affected cirrhosis in UKBB or MGI, we determined single nucleotide polymorphism effects on all other diagnoses in UKBB (PheWAS), common metabolic traits/diseases and serum/plasma metabolites. RESULTS:Unbiased genome-wide association study identified variants in/near PNPLA3 and HFE, and candidate variant analysis identified variants in/near TM6SF2, MBOAT7, SERPINA1, HSD17B13, STAT4 and IFNL4 that reproducibly affected cirrhosis. Most affected liver enzyme concentrations and/or aspartate transaminase-to-platelet ratio index. PheWAS, metabolic trait and serum/plasma metabolite association analyses revealed effects of these variants on lipid, inflammatory and other processes including new effects on many human diseases and traits. CONCLUSIONS:We identified eight loci that reproducibly associate with population-based cirrhosis and define their diverse effects on human diseases and traits.
METHODS:BACKGROUND:Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with liver cirrhosis. In recent years, it has been postulated that the rate of multidrug-resistant organisms (MDROs) is increasing, especially in nosocomial SBP patients. Aim of the present work was to investigate this hypothesis and its possible clinical consequences. MATERIALS AND METHODS:One hundred and three culture-positive patients between 2007 and 2014 were compared with 81 patients between 2015 and 2017, to study the change of microbiological profiles and their clinical consequences. The cirrhosis patients with bacterascites requiring treatment were included as well. RESULTS:The most prevalent Gram-negative bacteria isolated from ascites were Enterobacterales (31.6%) and in Gram-positive pathogens Staphylococci (22.8%). There was a significant increase in MDROs (22.3% ICU 40.7%, P = .048), accompanied by an increased incidence of sepsis (from 21.4% to 37.0%, P = .021), hepatorenal syndrome (from 40.8% to 58.0%, P = .007) and the need of catecholamine therapy (from 21.4% to 38.8%, P = .036). Nosocomial origin correlated with higher MDRO proportion, more complications and lower antimicrobial susceptibility rates in 12 commonly used antibiotics. MDROs were confirmed as an isolated predictor for inpatient mortality and complications in multivariable logistic regression. CONCLUSIONS:The feeling in clinical practice that MDROs have increased in the last 11 years could be confirmed in our study in Munich, Germany. Nosocomial SBP correlated with significantly higher MDRO rates (nearly 50%) and complication rates. In our opinion, an antibiotic combination with comprehensive effect should be taken into account in nosocomial SBP patients in this region.