外部验证REAL-B评分对抗病毒治疗的慢性乙型肝炎患者肝细胞癌发生风险的预测价值  

Value of external validation of REAL-B score in predicting the risk of hepatocellular carcinoma in chronic hepatitis B patients treated by antiviral therapy

作　　者：吴雪[1] 楚伟可 周辉 牛斌 张鹏[1] 冯婧 宓余强[2] 李萍[2] WU Xue;CHU Weike;ZHOU Hui;NIU Bin;ZHANG Peng;FENG Jing;MI Yuqiang;LI Ping(Clinical College of The Second People’s Hospital,Tianjin Medical University,Tianjin 300070,China;Tianjin Hepatopathy Research Institute,Tianjin Second People’s Hospital,Tianjin 300192,China)

机构地区：[1]天津医科大学,第二人民医院临床学院,天津300070 [2]天津市第二人民医院,天津市肝病医学研究所,天津300192

出　　处：《临床肝胆病杂志》2022年第8期1768-1773,共6页Journal of Clinical Hepatology

基　　金：中国肝炎防治基金会王宝恩肝纤维化研究基金(2021038)。

摘　　要：目的探究肝细胞癌(HCC)预测模型REAL-B评分对抗病毒治疗的慢性乙型肝炎患者HCC风险的预测性能,并与mPAGE-B、aMAP、PAGE-B评分进行比较。方法回顾性收集2013年1月—2015年12月天津市第二人民医院1160例接受1年以上恩替卡韦(ETV)或替诺福韦(TDF)治疗的慢性乙型肝炎患者的临床资料,并记录肝癌事件的发生。通过受试者工作特征曲线下面积(AUC)评估REAL-B、mPAGE-B、aMAP、PAGE-B评分对HCC的预测性能。采用Kaplan-Meier方法评估不同时间点HCC累积发生率,并通过log-rank检验比较不同评分分组间肝癌发生的差异。符合正态分布的计量资料2组间比较采用独立样本t检验;不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ^(2)检验。结果1160例慢性乙型肝炎患者中,有108(9.8%)例患者在中位随访5.3(5.0~6.3)年内进展为HCC。REAL-B评分预测5年内HCC发生的AUC及其95%CI为0.848(0.816~0.880),其次为aMAP评分[0.823(0.786~0.860)]、mPAGE-B评分[0.822(0.788~0.857)]和PAGE-B评分[0.780(0.736~0.824)]。在REAL-B评分低危组(0~3分)中,5年内肝癌累积发生率为0.8%,低于中危组(4~7分)11.8%和高危组(8~13分)35.6%(P<0.05)。REAL-B评分低危组中,3年和5年发生HCC的阴性预测值分别为100%和99.67%。结论REAL-B评分准确地预测了接受抗病毒治疗的慢性乙型肝炎患者HCC风险,并在抗病毒治疗3年中的预测价值优于其他风险模型。Objective To investigate the value of the hepatocellular carcinoma(HCC)risk model REAL-B score in predicting the risk of HCC in chronic hepatitis B(CHB)patients receiving antiviral therapy in comparison with mPAGE-B,aMAP and PAGE-B scores.Methods A retrospective analysis was performed for the clinical data of 1160 CHB patients who received entecavir or tenofovir treatment for more than 1 year from January 2013 to December 2015 in Tianjin Second Peolple’s Hospital,and the events of HCC were recorded.The area under the ROC curve(AUC)was used to evaluate the value of REAL-B,mPAGE-B,aMAP,and PAGE-B scores in predicting HCC.The Kaplan-Meier method was used to evaluate the cumulative incidence rate of HCC at different time points,and the log-rank test was used to compare the incidence rate of HCC between the groups with different scores.The independent samples t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups.ResultsAmong the 1160 CHB patients,108(9.8%)progressed to HCC within a median follow-up time of 5.3(5.0-6.3)years.REAL-B score had an AUC of 0.848(95%confidence interval[CI]:0.816-0.880)in predicting the onset of HCC within 5 years,followed by aMAP score(AUC=0.823,95%CI:0.786-0.860),mPAGE-B score(AUC=0.822,95%CI:0.788-0.857),and PAGE-B scores(AUC=0.780,95%CI:0.736-0.824).The 5-year cumulative incidence rate of HCC was 0.8%in the low-risk group(with a REAL-Bscore of 0-3 points),which was significantly lower than the incidence rate of 11.8%in the medium-risk group(with a REAL-B score of 4-7 points)and 35.6%with the high-risk group(with a REAL-B score of 8-13 points)(P<0.05).In the low-risk group,REAL-B score had a negative predictive value of 100%and 99.67%,respectively,in predicting HCC within 3 and 5 years.Conclusion REAL-B score accurately predicts the risk of HCC in CHB patients receiving

关 键 词：乙型肝炎 慢性 癌 肝细胞 危险因素 

分 类 号：R512.62[医药卫生—内科学] R735.7[医药卫生—临床医学]