藏区慢性乙型肝炎患者使用PAGE-B模型对肝细胞癌的风险预测研究

Risk prediction of hepatocellular carcinoma using the PAGE-B model in Tibetan patients with chronic hepatitis B

目的:使用PAGE-B模型评估接受恩替卡韦(ETV)或富马酸替诺福韦酯(TDF)治疗的藏区慢性乙型肝炎患者(CHB)发生肝细胞癌(HCC)的风险。方法:选择2014年6月—2017年3月就诊于昌都市藏医院,并接受ETV或TDF治疗的CHB患者,收集临床相关数据,分析PAGE-B模型的有效性,并与传统的预测模型CU-HCC和REACH-B进行比较。结果:共选择896例CHB患者(男性586例,占65.4%),平均年龄(46±15)岁。在随访期间32例(3.6%)患者发生HCC。年龄较大[危险比(HR)=1.073,95%CI:1.036-1.121]、男性(HR=3.681,95%CI:1.579-8.543)和血小板计数较低(HR=0.979,95%CI:0.971-0.992)是HCC发展的独立预测因素。PAGE-B模型预测3年时和5年时HCC发展的曲线下面积(AUC)分别为0.783和0.807,而CU-HCC模型分别为0.724、0.765,REACH-B模型分别为0.621、0.582。PAGE-B和CU-HCC的AUC相近,明显高于REACH-B模型。结论:PAGE-B适用于接受ETV或TDF治疗的藏区CHB患者,其预测性能与CU-HCC相似并优于REACH-B,因简便易行而适合在藏区应用。

Objective:To evaluate the risk of hepatocellular carcinoma(HCC)in Tibet patients with chronic hepatitis B(CHB)treated with entecavir(ETV)or tenofovir fumarate(TDF)using PAGE-B model.Methods:Patients with CHB infection who received ETV or TDF treatment in Tibetan Hospital of Changdu from June 2014 to March 2017 were selected.Clinical data were collected to analyze the validity of PAGE-B model,and to compare it with CU-HCC and REACH-B as the traditional prediction model.Results:A total of 896 patients(586 males,65.4%)with chronic hepatitis B were enrolled.The average age was 46±15.HCC occurred in 32 patients(3.6%)during follow-up.Older age[hazard ratio(HR)=1.073,95%CI:1.036-1.121],male sex(HR=3.681,95%CI:1.579-8.543)and low platelet count(HR=0.979,95%CI:0.971-0.992)were independent predictors of HCC development.The area under ROC curve predicted by PAGE-B model of HCC development in 3 years and 5 years were 0.783 and 0.807,while the CU-HCC model was 0.724 and 0.765.And the REACH-B model were 0.621 and 0.582.The area under ROC curve of PAGE-B and CU-HCC were similar and significantly higher than the REACH-B model.Conclusion:The study shows that PAGE-B is suitable for CHB patients receiving ETV or TDF treatment in Tibetan areas.PAGE-B shows similar predictive performance to CU-HCC and better than REACH-B,and is suitable for use in Tibetan areas because of its simplicity and easiness.