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

作　　者：赵耕 张盈莹 卓永 陈晓鸥[3] ZHAO Geng;ZHANG Ying-ying;ZHUO Yong;CHEN Xiao-ou(Department of Medical Laboratory,NHC Key Laboratory of Hormones and Development,Tianjin Key Laboratory of Metabolic Diseases,Tianjin Medical University Chu Hsien-I Memorial Hospital&Tianjin Institute of Endocrinology,Tianjin 300134,China;Department of Medical Laboratory,Changdu Tibetan Hospital of Tibet Autonomous Region,Changdu 854000,China;Department of Psychology,The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300193,China)

机构地区：[1]天津医科大学朱宪彝纪念医院检验科,国家卫生健康委员会激素与发育重点实验室,天津市代谢性疾病重点实验室,天津医科大学朱宪彝纪念医院&天津市内分泌研究所,天津300134 [2]西藏自治区昌都市藏医院检验科,昌都854000 [3]天津中医药大学第一附属医院心身科,天津300193

出　　处：《天津医科大学学报》2022年第6期654-658,671,共6页Journal of Tianjin Medical University

基　　金：天津市医学重点学科(专科)建设项目;天津医科大学朱宪彝纪念医院科研基金项目(2019ZDKF02)。

摘　　要：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.

关 键 词：乙肝患者肝癌风险预测模型PAGE-B 藏区慢性乙型肝炎 肝细胞癌 低风险组 高风险组 

分 类 号：R115[医药卫生—公共卫生与预防医学]