香港瑪麗女王醫(yī)院進行的研究顯示,，以慢性乙肝患者的性別,、年齡,、乙肝病毒(HBV)DNA水平,、核啟動子突變和肝硬化等為基礎的評分系統(tǒng)(GAGHCC),，可有效預測患者5年和10年的肝細胞肝癌(HCC)發(fā)生危險,。該研究發(fā)表于《肝臟病學雜志》(Journal of Hepatology 2009，50:80),。
820例慢性乙肝患者接受的平均為期76.8個月的隨訪顯示,，經(jīng)組織學或甲胎蛋白聯(lián)合影像學檢查證實的5年和10年HCC患病率分別為4.4%和6.3%。
多因素分析顯示,，男性[相對危險(RR)為2.98,，P=0.025]、年齡增加(RR=1.07,，P< 0.001),、HBV DNA水平高(RR=1.28，P=0.02),、核啟動子突變(RR=3.66,，P=0.007)及存在肝硬化(RR=7.31，P< 0.001)是發(fā)生HCC的獨立危險因素,。
綜合上述因素建立一個評分系統(tǒng)(并在驗證人群中驗證)預測HCC 5年和10年發(fā)生危險的敏感性>84%,，特異性>76%，5年和10年預測的曲線下面積分別為0.88和0.98,。評分臨界點為101分,，如果患者評分超過101分，其HCC危險將呈指數(shù)級升高,。
該評分系統(tǒng)可用于甄別哪些是需要篩查和治療的高危慢性乙肝患者,。
美國國立衛(wèi)生研究院科赫(Koh)和梁(Liang)認為，香港這項長達10年的研究建立了一個有效的HCC 5年和10年發(fā)病危險預測評分系統(tǒng),，該系統(tǒng)有助于HCC高危人群的識別,。
但該研究還存在一些不足，如研究中僅40例患者最終患HCC,，這對該評分系統(tǒng)有一定影響,。另外，該研究所納入的均為中國人,，因此,，該評分系統(tǒng)是否適用于其他種族的人群尚待研究,。（生物谷Bioon.com）
生物谷推薦原始出處：
Journal of Hepatology，doi:10.1016/j.jhep.2008.07.023 ,，Man-Fung Yuen,，Ching-Lung Lai
Independent risk factors and predictive score for the development of hepatocellular carcinoma in chronic hepatitis B
Man-Fung Yuen1, , , Yasuhito Tanaka2, Daniel Yee-Tak Fong3, James Fung1, Danny Ka-Ho Wong1, John Chi-Hang Yuen1, David Yiu-Kuen But1, Annie On-On Chan1, Benjamin Chun-Yu Wong1, Masashi Mizokami2 and Ching-Lung Lai1
1Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
2Department of Clinical Molecular Informative Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
3Department of Nursing Studies, The University of Hong Kong, Queen Mary Hospital, Hong Kong
Abstract
Background/Aims To determine whether gender, age, hepatitis B virus genotype, core promoter and precore mutations, HBeAg/ anti-HBe status, HBV DNA, ALT levels and cirrhosis on presentation were independent risk factors and derive a novel risk score for the development of HCC.
Methods CHB patients (820) were followed up (mean duration 76.8 months) for the occurrence of HCC.
Results The 5- and 10-year prevalence of HCC were 4.4% and 6.3%, respectively. Cox regression analysis showed that male gender (p = 0.025, RR 2.98), increasing age (p < 0.001, RR 1.07), higher HBV DNA levels (p = 0.02, RR 1.28), core promoter mutations (p = 0.007, RR 3.66), and presence of cirrhosis (p < 0.001, RR 7.31) were independent risks for the development of HCC. A risk score was derived and validated with sensitivity > 84% and specificity > 76% to predict the 5- and 10- year risks for the development of HCC. The AUC for the 5- and 10-year prediction were 0.88 and 0.89, respectively.
Conclusions The risk score, based on age, gender, HBV DNA levels, core promoter mutations and cirrhosis, can estimate the chance of development of HCC in 5 and 10 years after presentation. It can be used to identify high-risk CHB patients for treatment and screening of HCC.
