{"id":129670,"date":"2019-12-16T11:55:50","date_gmt":"2020-04-21T02:45:15","guid":{"rendered":"http:\/\/www.05921.net\/index.php\/129670\/"},"modified":"2020-04-21T10:45:16","modified_gmt":"2020-04-21T02:45:16","slug":"2d7efa1c04","status":"publish","type":"post","link":"https:\/\/www.05921.net\/index.php\/129670\/","title":{"rendered":"AASLD \u5feb\u62a5|\u6700\u65b0\u7814\u7a76\u7ed3\u679c\u8868\u660e\u66ff\u8bfa\u798f\u97e6\uff08TFV\uff09\u8f83\u6069\u66ff\u5361\u97e6\uff08ETV\uff09\u964d\u4f4e\u809d\u764c\u53d1\u751f"},"content":{"rendered":"
\n
\n

\u7f16\u8005\u6309\uff1a<\/span><\/strong>\u6297\u75c5\u6bd2\u6cbb\u7597\u5bf9 CHB \u60a3\u8005\u7684\u6cbb\u7597\u7ed3\u5c40\u548c\u75be\u75c5\u8fdb\u5c55\u662f\u81f3\u5173\u91cd\u8981\u7684\u3002<\/span><\/span>\u7814\u7a76\u8bc1\u660e\uff0c\u6297\u75c5\u6bd2\u6cbb\u7597\u80fd\u591f\u964d\u4f4e CHB \u60a3\u8005 HCC \u7684\u53d1\u751f\u98ce\u9669\u3002TDF \u548c ETV \u662f CHB \u60a3\u8005\u6297\u75c5\u6bd2\u6cbb\u7597\u7684\u4e00\u7ebf\u63a8\u8350\u836f\u7269\uff0c\u4f46\u4e24\u79cd\u836f\u7269\u964d\u4f4e\u809d\u764c\u98ce\u9669\u7684\u6548\u679c\u5b70\u4f18\u5b70\u52a3\u5c1a\u672a\u6709\u51b3\u65ad\u30022019 AASLD \u5e74\u4f1a\uff0c4 \u7bc7\u63a2\u7a76 TDF \u548c ETV \u964d\u4f4e\u809d\u764c\u98ce\u9669\u7684\u6458\u8981\u5165\u9009\uff0c\u6700\u65b0\u6570\u636e\u4e3a\u66ff\u8bfa\u798f\u97e6\u4e34\u5e8a\u7597\u6548\u53d1\u58f0\uff01<\/span><\/p>\n


<\/p>\n


<\/p>\n

TDF \u8f83 ETV \u964d\u4f4e CHB \u60a3\u8005 HCC \u53d1\u751f\u98ce\u9669\uff0c\u4e9a\u6d32\u4eba\u7fa4\u6548\u679c\u663e\u8457<\/span><\/strong><\/span><\/p>\n


<\/p>\n

\u6b64\u6b21 AASLD\uff0c\u6709 3 \u7bc7\u5165\u9009\u6458\u8981\u5bf9\u4e9a\u6d32\u4eba\u7fa4\u63a5\u53d7 TDF \u6216 ETV \u6cbb\u7597 HCC \u53d1\u751f\u60c5\u51b5\u8fdb\u884c\u4e86\u6bd4\u8f83\u3002\u7ed3\u679c\u4e00\u81f4\u8868\u660e\uff0cTDF \u8f83 ETV \u964d\u4f4e\u4e9a\u6d32 CHB \u60a3\u8005\uff0c\u4ee5\u53ca\u5408\u5e76\u809d\u786c\u5316 CHB \u60a3\u8005\u7684 HCC \u53d1\u751f\u98ce\u9669\u3002<\/span><\/p>\n


<\/p>\n


<\/p>\n

\u7814\u7a76\u4e00\uff1a<\/strong><\/span>\u63a5\u53d7 ETV \u6216 TDF \u6cbb\u7597\u7684 CHB \u60a3\u8005 HC<\/strong>C \u7684\u53d1\u751f<\/strong>\u60c5\u51b5 <\/span>[1]<\/sup><\/span><\/strong><\/span><\/section>\n


<\/p>\n

\u6838\u82f7\uff08\u9178\uff09\u7c7b\u4f3c\u7269\uff08NA\uff09\u6cbb\u7597\uff0c\u5305\u62ec ETV \u6216 TDF\uff0c\u5df2\u7ecf\u88ab\u8bc1\u5b9e\u65e2\u80fd\u591f\u964d\u4f4e CHB \u60a3\u8005 HCC \u53d1\u751f\u98ce\u9669\u3002\u6709\u4e9b\u7814\u7a76\u66fe\u62a5\u9053 TDF \u8f83 ETV \u964d\u4f4e HCC \u98ce\u9669\uff0c\u8fd9\u7bc7\u7814\u7a76\u6bd4\u8f83\u4e86 TDF \u548c ETV \u5bf9\u4e9a\u6d32 CHB \u60a3\u8005 HCC \u53d1\u751f\u7684\u5f71\u54cd\u3002<\/span><\/p>\n


<\/p>\n

\u6570\u636e\u622a\u6b62\u65f6\uff0c\u7eb3\u5165\u7814\u7a76\u7684 740 \u4f8b\u60a3\u8005\u4e2d\uff0c39 \u4f8b\u53d1\u5c55\u4e3a HCC\uff0c\u5176\u4e2d ETV \u7ec4 HCC \u53d1\u751f\u7387\u4e3a 0.016\/\u4eba\u5e74\uff0cTDF \u7ec4 HCC \u53d1\u751f\u7387\u4e3a 0.009\/\u4eba\u5e74\u3002\u7ed3\u679c\u8868\u660e\uff0cTDF \u7ec4\u60a3\u8005\u7684 HCC \u53d1\u751f\u7387\u5728\u6570\u503c\u4e0a\u4f4e\u4e8e ETV \u7ec4\uff0c\u4f46\u6ca1\u6709\u7edf\u8ba1\u5b66\u610f\u4e49\u3002\u9ad8\u9f84\uff08\u2265 50 \u5c81\uff09\u3001\u809d\u786c\u5316\u4ecd\u7136\u662f HCC \u7684\u76f8\u5173\u56e0\u7d20\u3002<\/span><\/span><\/p>\n


<\/p>\n


<\/p>\n

<\/strong>\u7814\u7a76\u4e8c\uff1a<\/span><\/strong>TDF \u8f83 ETV \u663e\u8457\u964d\u4f4e\u5408\u5e76\u809d\u786c\u5316 CHB \u60a3\u8005\u7684 HCC \u53d1\u751f<\/span><\/strong><\/span>\u98ce\u9669 [2]<\/sup><\/strong><\/sup><\/strong><\/strong><\/strong><\/span><\/p>\n


<\/p>\n

\u8fd9\u9879\u7814\u7a76\u6bd4\u8f83\u5206\u6790\u4e86\u63a5\u53d7 ETV \u548c TDF \u521d\u6cbb\u5bf9\u4e9a\u6d32\u5408\u5e76\u809d\u786c\u5316 CHB \u60a3\u8005 HCC \u53d1\u751f\u7684\u5f71\u54cd\u3002216 \u4f4d\u60a3\u8005\u63a5\u53d7 TDF \u6cbb\u7597\uff0c678 \u4f4d\u60a3\u8005\u63a5\u53d7 ETV \u6cbb\u7597\u3002\u5728\u968f\u8bbf\u7b2c 1 \u5e74\u3001\u7b2c 3 \u5e74\u3001\u7b2c 5 \u5e74\u65f6\uff0cHCC \u7684\u7d2f\u8ba1\u53d1\u751f\u7387\u5206\u522b\u4e3a 1.5%\u300110.3%\u300117.0%\u3002<\/span><\/p>\n


<\/p>\n

\u5355\u56e0\u7d20\u548c\u591a\u56e0\u7d20\u5206\u6790\u7ed3\u679c\u8868\u660e\uff0c\u8840\u5c0f\u677f\u8ba1\u6570\u4f4e\u3001\u809d\u7ea4\u7ef4\u5316\u6307\u6570\uff08FIB-4\uff09\u9ad8\u3001\u7cd6\u5c3f\u75c5\u662f\u5408\u5e76\u809d\u786c\u5316 CHB \u60a3\u8005\u53d1\u5c55\u4e3a\u809d\u764c\u7684\u72ec\u7acb\u9884\u6d4b\u56e0\u7d20\u3002TDF \u7ec4\u60a3\u8005 HCC \u53d1\u751f\u7387\u663e\u8457\u4f4e\u4e8e ETV \u7ec4\uff08p = 0.024\uff09\u3002<\/span><\/p>\n

<\/section>\n


<\/p>\n

\u7814\u7a76\u4e09\uff1a<\/span><\/strong>\u4e00\u9879\u835f\u8403\u5206\u6790\uff1a<\/span><\/strong>TDF \u4e0e ETV \u964d\u4f4e CHB \u60a3\u8005 HCC \u98ce\u9669\u7684\u6bd4\u8f83 [3]<\/sup><\/strong><\/sup><\/strong><\/strong><\/span><\/strong><\/span><\/section>\n
<\/section>\n
\u4f5c\u8005\u5728 MEDLINE\u3001Embase \u548c Cochrane Library \u4e0a\u68c0\u7d22\u4e86\u622a\u81f3 2019 \u5e74 4 \u6708 30 \u65e5\u7684\u6570\u636e\uff0c\u5171\u7eb3\u5165 10 \u9879\u7814\u7a76\u300155,827 \u4f8b\u60a3\u8005\u3002\u5176\u4e2d\uff0cTDF \u7ec4 20,366 \u4f8b\u60a3\u8005\uff0cETV \u7ec4\u60a3\u8005 35,461 \u4f8b\u60a3\u8005\uff0c\u7814\u7a76\u7684\u4e3b\u8981\u7ec8\u70b9\u662f\u8fdb\u5c55\u4e3a HCC\u3002<\/span><\/section>\n

<\/span><\/section>\n
<\/section>\n
\u7814\u7a76\u7ed3\u679c\u8868\u660e\uff0cTDF \u7ec4 HCC \u53d1\u751f\u7387\u4e3a 3.2%\uff0cETV \u7ec4\u4e3a 4.0%\u3002\u4e0e ETV \u76f8\u6bd4\uff0cTDF \u663e\u8457\u51cf\u5c11\u4e86\u809d\u764c\u7684\u53d1\u751f\uff08RR 0.60\uff1b95% CI 0.40-0.72\uff1bI2 = 43%\uff09\u3002<\/span><\/section>\n


<\/p>\n

\u4e9a\u7ec4\u4eba\u7fa4\u5206\u6790\u7ed3\u679c\u8868\u660e\uff0c\u5728\u4e9a\u6d32 CHB \u60a3\u8005\u4e2d TDF \u8f83 ETV \u7597\u6548\u663e\u8457\uff08RR 0.58\uff1b95% CI\uff0c0.50-0.67\uff1bI2 = 29%\uff09\uff0c\u5728\u897f\u65b9\u4eba\u7fa4\u4e2d\uff0c\u5219\u65e0\u663e\u8457\u5dee\u5f02\uff08RR 1.65\uff1b95% CI 0.81-3.39\uff1bI2 = 0%\uff09\uff08\u5982\u56fe 1\uff09\u3002<\/span><\/p>\n

\"AASLD<\/span><\/p>\n

\u56fe 1<\/span><\/p>\n


<\/p>\n


<\/p>\n

TDF \u8f83 ETV \u663e\u8457\u964d\u4f4e CHB \u60a3\u8005 HCC \u53d1\u751f\u98ce\u9669\uff0c\u7f8e\u56fd\u6570\u636e\u4e0e\u4e9a\u6d32\u6570\u636e\u4e00\u81f4<\/span><\/strong><\/span><\/p>\n


<\/p>\n

\u7814\u7a76\u4e09\u4e2d\uff0cTDF \u4e0e ETV \u964d\u4f4e HCC \u53d1\u751f\u98ce\u9669\u7684\u663e\u8457\u5dee\u5f02\u5728\u897f\u65b9\u4eba\u7fa4\u4e2d\u5e76\u672a\u4f53\u73b0\u3002\u4f46\u6b64\u6b21 AASLD \u4e0a\u7684\u4e00\u9879\u7f8e\u56fd\u7814\u7a76\u5374\u7ed9\u51fa\u4e86\u4e0e\u4e9a\u6d32\u6570\u636e\u4e00\u81f4\u7684\u7ed3\u679c\u3002<\/span><\/p>\n


<\/p>\n


<\/p>\n

\u7814\u7a76\u56db\uff1a<\/span><\/strong>\u4e00\u9879\u7f8e\u56fd\u533b\u4fdd\u6570\u636e\u5206\u6790\uff1a<\/span><\/strong>CHB \u60a3\u8005\u63a5\u53d7 TDF \u6216 ETV \u5bf9 HCC \u53d1\u751f\u98ce\u9669\u7684\u6bd4\u8f83 <\/span><\/strong>[4]<\/sup><\/strong><\/span><\/section>\n


<\/p>\n

\u8fd9\u9879\u7814\u7a76\u5206\u6790\u6bd4\u8f83\u4e86\u7f8e\u56fd\u533b\u4fdd\u62a5\u9500\u6570\u636e\u5e93\u4e2d 2006 \u5e74 1 \u6708-2018 \u5e74 9 \u6708\u672a\u7ecf\u6cbb\u7597\u7684 CHB \u60a3\u8005\u63a5\u53d7 TDF \u6216 ETV \u6cbb\u7597\u81f3\u5c11\u4e00\u5e74\u540e\u7684 HCC \u957f\u671f\u98ce\u9669\u3002\u7eb3\u5165 10205 \u4f8b\u672a\u7ecf\u6cbb\u7597\u7684 CHB \u60a3\u8005\uff0cTDF \u7ec4 6,145 \u4f8b\uff0cETV \u7ec4 4,060 \u4f8b\u3002<\/span><\/section>\n

<\/span><\/section>\n
<\/section>\n
\u7ed3\u679c\u8868\u660e,TDF \u7ec4\u60a3\u8005\u7edd\u5bf9 HCC \u53d1\u751f\u7387\u7ea6\u4e3a ETV \u7ec4\u60a3\u8005 HCC \u53d1\u751f\u7387\u7684 1\/2\uff0c\u4e0e ETV \u7ec4\u76f8\u6bd4\uff0cTDF \u7ec4\u6821\u6b63\u540e HCC \u53d1\u751f\u98ce\u9669\u663e\u8457\u66f4\u4f4e (HR 0.56\uff0c95% CI 0.37-0.86)\u3002\u8fd9\u4e2a\u7ed3\u679c\u4e0e\u4e9a\u6d32\u6570\u636e\u7684\u5206\u6790\u7ed3\u679c\u662f\u4e00\u81f4\u7684\u3002<\/span><\/span><\/section>\n

<\/span><\/section>\n
<\/section>\n
\"AASLD<\/section>\n
<\/section>\n


<\/p>\n


<\/p>\n


<\/p>\n

\u66ff\u8bfa\u798f\u97e6\uff08TFV\uff09\u4e0e\u6069\u66ff\u5361\u97e6\uff08ETV\uff09\u4e34\u5e8a\u7597\u6548\u7684\u5dee\u5f02\uff0c\u53ef\u80fd\u6e90\u4e8e\u7ed3\u6784\u548c\u4f5c\u7528\u673a\u5236\u7684\u4e0d\u540c<\/span><\/strong><\/span><\/p>\n


<\/p>\n

TDF \u4e0e ETV \u4f5c\u4e3a CHB \u60a3\u8005\u6297\u75c5\u6bd2\u6cbb\u7597\u7684\u4e00\u7ebf\u7528\u836f\uff0c\u4e3a\u4f55\u5728\u964d\u4f4e HCC \u53d1\u751f\u98ce\u9669\u4e0a\u5177\u6709\u5982\u6b64\u663e\u8457\u7684\u5dee\u5f02\u30022019 \u5e74 9 \u6708\u53d1\u8868\u5728 Hepatology \u4e0a\u7684\u4e00\u7bc7\u6587\u7ae0\u7ed9\u51fa\u4e86\u7b54\u6848 [5]<\/sup>\u3002<\/span><\/p>\n


<\/section>\n
\u65e0\u73af\u6838\u82f7\u81a6\u9178\u916f\uff08ANP\uff0c\u5982\u963f\u5fb7\u798f\u97e6\u916f [ADV] \u3001\u4e19\u915a\u66ff\u8bfa\u798f\u97e6\uff08TAF\uff09\u548c\u5bcc\u9a6c\u9178\u66ff\u8bfa\u798f\u97e6\u4e8c\u5421\u544b\u916f [TDF]\uff09\u548c\u6838\u82f7\u7c7b\u4f3c\u7269\uff08\u5982\u62c9\u7c73\u592b\u5b9a [LAM] \u548c\u6069\u66ff\u5361\u97e6 [ETV]\uff09\u90fd\u662f DNA \u94fe\u7684\u7ec8\u6b62\u5242\uff0c\u5176\u4ee3\u8c22\u4ea7\u7269\u80fd\u591f\u5728\u75c5\u6bd2 DNA \u901a\u8fc7\u805a\u5408\u9176\u6216\u9006\u8f6c\u5f55\u9176\u8fdb\u884c\u590d\u5236\u65f6\uff0c\u63ba\u5165\u75c5\u6bd2 DNA \u94fe\u4e2d\uff1b\u6b64\u5916\uff0c\u4e8c\u8005\u5728\u63a7\u5236 HBV \u65b9\u9762\u7684\u529f\u80fd\u76f8\u4f3c\u3002\u4f46\u662f ANP \u4e0e\u6838\u82f7\u7c7b\u4f3c\u7269\u4e0d\u4ec5\u5728\u7ed3\u6784\u4e0a\u5b58\u5728\u5dee\u5f02\uff0c\u800c\u4e14\u5728\u529f\u80fd\u4e0a\u4e5f\u6709\u6240\u4e0d\u540c\u3002<\/span><\/section>\n

<\/span><\/section>\n
<\/section>\n
ANP \u5177\u6709\u78f7\u9178\u916f\u90e8\u5206\uff0c\u4e0e\u6838\u82f7\u7c7b\u4f3c\u7269\u4e0d\u540c\uff0c\u5e76\u56e0\u6b64\u5177\u6709\u4e0d\u540c\u7684\u4f5c\u7528\u673a\u5236\u3002ANP \u4f5c\u7528\u65f6\u95f4\u66f4\u957f\uff0c\u5e76\u4e14\u53ef\u5728\u80c3\u80a0\u9053\u4e2d\u8bf1\u5bfc\u5e72\u6270\u7d20\uff08IFN\uff09-\u03bb3\u3002\u5728 NUC \u4e2d\uff0c\u4ec5 ANP \u5177\u6709\u8c03\u8282\u8102\u591a\u7cd6\uff08lipopolysaccharide, LPS\uff09\u4ecb\u5bfc\u7684\u7ec6\u80de\u56e0\u5b50\u4ea7\u751f\u7684\u989d\u5916\u836f\u7406\u4f5c\u7528\uff08\u5982\u56fe 2\uff09\uff0c\u6709\u671b\u4ea7\u751f\u5bf9\u6d88\u9664 HBV \u6709\u5229\u7684\u514d\u75ab\u53cd\u5e94\u3002\u8fd9\u53ef\u80fd\u4e3a HBV \u6cbb\u7597\u63d0\u4f9b\u65b0\u7684\u601d\u8def\uff0c\u5e76\u6709\u52a9\u4e8e\u52a0\u5f3a\u5bf9 ANP \u7279\u5f81\u7684\u8ba4\u8bc6\u3002<\/span><\/span><\/section>\n

<\/span><\/section>\n
<\/section>\n
\"AASLD\u56fe 2<\/span><\/section>\n

<\/section>\n

<\/section>\n

<\/section>\n

\u603b\u7ed3<\/span><\/strong><\/span><\/p>\n


<\/p>\n

\u6297\u75c5\u6bd2\u6cbb\u7597\u80fd\u591f\u663e\u8457\u6539\u5584 CHB \u60a3\u8005\u7684\u75be\u75c5\u8fdb\u5c55\u548c\u6cbb\u7597\u7ed3\u5c40\uff0c\u5bf9 HCC \u7684\u98ce\u9669\u964d\u4f4e\u4e5f\u662f\u6709\u6548\u7684\u3002TDF \u548c ETV \u4f5c\u4e3a CHB \u60a3\u8005\u6297\u75c5\u6bd2\u6cbb\u7597\u4e00\u7ebf\u63a8\u8350\u836f\u7269\uff0c\u7597\u6548\u5dee\u5f02\u4e00\u76f4\u662f\u4e34\u5e8a\u5173\u6ce8\u7684\u91cd\u70b9\u3002\u66ff\u8bfa\u798f\u97e6\uff08TFV\uff09\u4e0e\u6069\u66ff\u5361\u97e6\uff08ETV\uff09\u4e34\u5e8a\u7597\u6548\u7684\u5dee\u5f02\uff0c\u6e90\u4e8e\u7ed3\u6784\u548c\u4f5c\u7528\u673a\u5236\u7684\u4e0d\u540c\u3002\u591a\u9879\u4e34\u5e8a\u7814\u7a76\u7ed3\u679c\u8868\u660e\uff0c\u66ff\u8bfa\u798f\u97e6\uff08TFV\uff09\u80fd\u591f\u8f83\u6069\u66ff\u5361\u97e6\uff08ETV\uff09\u663e\u8457\u964d\u4f4e HCC \u53d1\u751f\u98ce\u9669\u3002<\/span><\/p>\n


<\/p>\n


<\/p>\n

\u672c\u6587\u9996\u53d1\u4e8e\u5fae\u4fe1\u516c\u4f17\u53f7\u56fd\u9645\u809d\u75c5\uff08ID\uff1aihepatology\uff09\u6388\u6743\u8f6c\u8f7d\u53d1\u5e03<\/span><\/p>\n

\u8d23\u7f16\uff1akendy<\/span><\/p>\n


<\/p>\n

\u6b22\u8fce\u5411\u62a5\u6599\uff01<\/span><\/em><\/span>\u8bf7\u52a0\u5fae\u4fe1\uff1adxylzzb<\/span><\/em><\/p>\n

\"AASLD<\/p>\n


<\/p>\n

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1.<\/span>Chieh-Ju Lee, Chien-Wei Su1, Han-Chieh Lin, et al. Occurrence of hepatocellular carcinoma in chronic hepatitis B patients undergoing entecavir or tenofvir treatment. AASLD2019, Poster 944.<\/span><\/p>\n

2.<\/span>Kuo-Chin Chang, Tsung-Hui Hu, Jing-Houng Wang, et al. Tenofovir reduce risk of hepatocellular carcinoma development higher than entecavir in chronic B hepatitis patients with liver cirrhosis. AASLD2019, Poster 495.<\/span><\/p>\n

3.<\/span>Choi WM, Choi J, Lim YS. Tenofovir compared to entecavir on risk of hepatocellular carcinoma in patients with chronic hepatitis B: A Systematic review and meta-analysis. AASLD2019, Poster 484.<\/span><\/p>\n

4.W. Ray Kim, Laura Telep, Mei Lu, et al. Risk of incident hepatocellular carcinoma in hepatitis B-infected patients treated with tenofovir disoproxil fumarate versus entecavir: A US administrative claims analysis. AASLD2019, Poster 478.<\/span><\/span>
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5.<\/span>Murata K, Tsukuda S, Suizu F, et al. Immunomodulatory mechanism of acyclic nucleoside phosphates in treatment of hepatitis B virus infection. Hepatology. 2019 Sep 17.<\/span><\/p>\n<\/section>\n


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