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Management of entecavir-resistant chronic hepatitis B with adefovir-based combination therapies 被引量:13
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作者 Hyoung Su Kim Hyung Joon Yim +18 位作者 Myoung Kuk Jang Ji Won Park Sang Jun Suh Yeon Seok Seo Ji Hoon Kim Bo Hyun Kim Sang Jong Park Sae Hwan Lee Sang Gyune Kim Young Seok Kim Jung Il Lee Jin-Woo Lee In Hee Kim Tae Yeob Kim Jin-Wook Kim sook-hyang jeong Young Kul Jung Hana Park Seong Gyu Hwang 《World Journal of Gastroenterology》 SCIE CAS 2015年第38期10874-10882,共9页
AIM: To evaluate the long-term efficacy adefovir(ADV)-based combination therapies in entecavir(ETV)-resistant chronic hepatitis B(CHB) patients. METHODS: F i fty CHB pat ient s wi t h genotypic resistance to ETV at 13... AIM: To evaluate the long-term efficacy adefovir(ADV)-based combination therapies in entecavir(ETV)-resistant chronic hepatitis B(CHB) patients. METHODS: F i fty CHB pat ient s wi t h genotypic resistance to ETV at 13 medical centers in South Korea were included for the analysis. All the patients received rescue therapy with the combination of ADV plus ETV(ADV/ETV,n = 23) or ADV plus lamivudine(LMV)(ADV/LMV,n = 27) for more than 12 mo. Patients were monitored at least every 3-4 mo during ADV-based combination therapy by clinical examination as well as biochemical and virological assessments. Hepatitis B virus(HBV) DNA levels were measured by realtime PCR and logarithmically transformed for analysis. Cumulative rates of virologic response(VR; HBV DNA < 20 IU/m L) were calculated using the Kaplan-Meier method,and the difference was determined by a logrank test. Multivariate logistic regression and Cox proportional hazards models were used to identify independent risk factors significantly associated with short-term and long-term VR,respectively.RESULTS: Baseline median HBV DNA levels were 5.53(2.81-7.63) log10 IU/m L. The most commonly observed ETV genotypic mutation sites were rt184 and rt202. Patients were treated for a median of 27(12-45) mo. Overall,cumulative VR rates at 6,12,24,and 36 mo were 26%,36%,45%,and 68%,respectively. Patients treated with the ADV/ETV combination showed higher cumulative VR rates(35%,43%,65%,and 76%,respectively) than those with the ADV/LAM combination(18%,30%,30%,and 62%,respectively; P = 0.048). In the multivariate analysis,low baseline HBV DNA levels(< 5.2 log10 IU/m L) and initial virologic response at 3 mo(IVR-3; HBV DNA < 3.3 log10 IU/m L after 3 mo) were independent predictive factors for VR. Patients with favorable predictors achieved cumulative VR rates up to 90% at 36 mo. During the same period,the cumulative incidence of virologic breakthrough was as low as 6% in patients with the both favorable predictors.CONCLUSION: If tenofovir is not available,ADV/ETV combination could be considered in ETV-resistant patients with low HBV DNA titers,and may becontinued if IVR-3 is achieved. 展开更多
关键词 ADEFOVIR CHRONIC HEPATITIS B ENTECAVIR LAMIVUDINE
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Prognostic role of plasma level of angiopoietin-1,angiopoietin-2,and vascular endothelial growth factor in hepatocellular carcinoma 被引量:4
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作者 Gwang Hyeon Choi Eun Sun Jang +1 位作者 Jin-Wook Kim sook-hyang jeong 《World Journal of Gastroenterology》 SCIE CAS 2021年第27期4453-4467,共15页
BACKGROUND Most hepatocellular carcinomas(HCCs)are hypervascular,with characteristic features of hepatic arterial supply to the tumor.The factors involved in tumor angiogenesis include angiopoietin-1(Ang-1),angiopoiet... BACKGROUND Most hepatocellular carcinomas(HCCs)are hypervascular,with characteristic features of hepatic arterial supply to the tumor.The factors involved in tumor angiogenesis include angiopoietin-1(Ang-1),angiopoietin-2(Ang-2),and vascular endothelial growth factor(VEGF).AIM To investigate the profiles of plasma levels of angiogenesis markers in patients with HCC and evaluate their roles in predicting overall survival(OS)and progression-free survival(PFS).METHODS Plasma samples from 240 prospectively enrolled HCC patients in the very early to advanced stages were used to measure the levels of Ang-1,Ang-2,and VEGF.Their associations with clinical characteristics,OS,and PFS were analyzed.RESULTS The median plasma levels of Ang-1,Ang-2,and VEGF were 3216 pg/mL,1684 pg/mL,and 26.5 pg/mL,respectively.The plasma level of Ang-2 showed a significant increase from early stage[Barcelona clinic liver cancer(BCLC)A]to intermediate(BCLC B)and advanced stage HCC(BCLC C/D),whereas Ang-1,VEGF,and alpha-fetoprotein(AFP)levels in the plasma did not show any such changes.Multivariable analysis,propensity score-matched analysis,and timedependent receiver operating curve analysis revealed that Ang-2 levels had the highest predictive power for OS and PFS.Neither Ang-1 nor VEGF was significantly associated with OS or PFS.The neutrophil-to-lymphocyte ratio was an independent factor for OS and PFS.CONCLUSION The plasma levels of Ang-2 correlated with liver function,tumor stage,and tumor invasiveness,showing better performance in predicting OS and PFS than AFP,Ang-1,or VEGF. 展开更多
关键词 Hepatocellular carcinoma ANGIOGENESIS Biomarker Prognosis Survival
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Occult hepatitis B virus infection is not associated with disease progression of chronic hepatitis C virus infection 被引量:1
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作者 Junhyeon Cho Sang Soo Lee +7 位作者 Yun Suk Choi Yejoo Jeon Jung Wha Chung Joo Yeong Baeg Won Keun Si Eun Sun Jang Jin-Wook Kim sook-hyang jeong 《World Journal of Gastroenterology》 SCIE CAS 2016年第42期9427-9436,共10页
AIM To clarify the prevalence of occult hepatitis B virus(HBV) infection(OBI) and the association between OBI and liver disease progression, defined as development of liver cirrhosis or hepatocellular carcinoma(HCC), ... AIM To clarify the prevalence of occult hepatitis B virus(HBV) infection(OBI) and the association between OBI and liver disease progression, defined as development of liver cirrhosis or hepatocellular carcinoma(HCC), worsening of Child-Pugh class, or mortality in cases of chronic hepatitis C virus(HCV) infection. METHODS This prospective cohort study enrolled 174 patients with chronic HCV infection(chronic hepatitis, n = 83; cirrhosis, n = 47; HCC, n = 44), and evaluated disease progression during a mean follow-up of 38.7 mo. OBI was defined as HBV DNA positivity in 2 or moredifferent viral genomic regions by nested polymerase chain reaction using 4 sets of primers in the S, C, P and X open reading frame of the HBV genome. RESULTS The overall OBI prevalence in chronic HCV patients at enrollment was 18.4%, with 16.9%, 25.5% and 13.6% in the chronic hepatitis C, liver cirrhosis and HCC groups, respectively(P = 0.845). During follow-up, 52 patients showed disease progression, which was independently associated with aspartate aminotransferase > 40 IU/L, Child-Pugh score and sustained virologic response(SVR), but not with OBI positivity. In 136 patients who were not in the SVR state during the study period, OBI positivity was associated with neither disease progression, nor HCC development. CONCLUSION The prevalence of OBI in chronic HCV patients was 18.4%, and OBI was not associated with disease progression in South Koreans. 展开更多
关键词 肝炎 B 病毒 丙肝病毒 疾病控制 ONCOGENESIS
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Hepatocellular carcinoma,decompensation,and mortality based on hepatitis C treatment:A prospective cohort study
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作者 Gwang Hyeon Choi Eun Sun Jang +9 位作者 Young Seok Kim Youn Jae Lee In Hee Kim Sung Bum Cho Han Chu Lee jeong Won Jang Moran Ki Hwa Young Choi Dahye Baik sook-hyang jeong 《World Journal of Gastroenterology》 SCIE CAS 2022年第30期4182-4200,共19页
BACKGROUND Prospective studies of the long-term outcomes of patients with hepatitis C virus(HCV)infection after treatment with interferon-based therapy(IBT)or directacting antivirals(DAA)are limited in many Asian coun... BACKGROUND Prospective studies of the long-term outcomes of patients with hepatitis C virus(HCV)infection after treatment with interferon-based therapy(IBT)or directacting antivirals(DAA)are limited in many Asian countries.AIM To elucidate the incidences of hepatocellular carcinoma(HCC)and death/transplantation based on treatment with IBT or DAA,to compare the outcomes of the sustained virologic response(SVR)to IBT and DAA,and to investigate outcome-determining factors after SVR.METHODS This cohort included 2054 viremic patients(mean age,57 years;46.5%male;27.4%with cirrhosis)prospectively enrolled at seven hospitals between 2007 and 2019.They were classified as the untreated group(n=619),IBT group(n=578),and DAA group(n=857).Outcomes included the incidences of HCC and death/transplantation.The incidences of the outcomes for each group according to treatment were calculated using an exact method based on the Poisson distribution.A multivariate Cox regression analysis was performed to determine the factors associated with HCC or death/transplantation,followed by propensity score matching to confirm the results.RESULTS During a median of 4.1 years of follow-up,HCC and death/transplantation occurred in 113 and 206 patients,respectively,in the entire cohort.Compared with the untreated group,the incidences of HCC and death/transplantation were significantly lower in the IBT group[adjusted hazard ratio(aHR)0.47,95%CI:0.28-0.80 and aHR 0.28,95%CI:0.18-0.43,respectively]and the DAA group(aHR 0.58,95%CI:0.35-0.96,and aHR 0.19,95%CI:0.20-0.68,respectively).Among 1268 patients who attained SVR with IBT(n=451)or DAA(n=816),the multivariable-adjusted analysis showed no differences in the risks of HCC(HR 2.03;95%CI:0.76-5.43)and death/transplantation(HR 1.38;95%CI:0.55-3.49)between the two groups.This was confirmed by a propensity score-matching analysis.Independent factors for HCC after SVR were age,genotype 1,and the presence of cirrhosis.CONCLUSION Treatment and achieving SVR with either IBT or DAA significantly reduced the incidences of HCC and mortality in the Asian patients with HCV infection.The risks of HCC and mortality were not significantly different regardless of whether SVR was induced by IBT or DAA. 展开更多
关键词 Hepatitis C virus Direct-acting antiviral Sustained virologic response Hepatocellular carcinoma MORTALITY
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