Long-term Repeated Measurements of Hepatitis B viral Load and the Risks of Hepatocellular Carcinoma/Liver Cirrhosis
| Autor: | Chuen-Fei Chen, 陳春妃 |
|---|---|
| Rok vydání: | 2011 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 99 This thesis consists of two component studies to investigate long-term changes in serum levels of hepatitis B virus (HBV) DNA and the risks of hepatocellular carcinoma and liver cirrhosis. PART 1: Long-term Changes in HBV DNA Predict Risk of Hepatocellular Carcinoma Background & Aims: Serum HBV DNA levels may vary markedly in the natural progression of chronic hepatitis B. It is not clear whether risk for hepatocellular carcinoma can be accurately determined from long-term changes in serum levels of HBV DNA or alanine aminotransferase (ALT). Methods: We measured serum levels of HBV DNA and ALT at enrollment and during follow-up analysis of 3,160 participants in the REVEAL-HBV study. Development of hepatocellular carcinoma was determined from follow-up examinations and computerized linkage with National Cancer Registry and National Death Certification profiles. The group-based trajectory model was used to identify distinctive groups of long-term changes in serum HBV DNA levels over 11 years of follow-up. Multivariate-adjusted hazard ratios [HRs] and 95% confidence intervals [CI] were estimated using Cox regression models. Results: During 38,330 person-years of follow-up, 81 participants developed hepatocellular carcinoma (incidence rate, 211.3/100,000 person-years). The hepatocellular carcinoma risk was only slightly higher for participants whose follow-up levels of HBV DNA spontaneously decreased to 10,000,000 copies/mL to 10,000,000 copies/mL to 100,000–1,000,000 copies/mL, or persisted at 1,000,000–10,000,000 copies/mL were 2.46 (1.19–5.13), 2.92 (1.94–4.39), 4.10 (2.51–6.72),and 4.81 (2.94–7.87), respectively. A gradient in ALT level was significantly associated with liver cirrhosis risk: from all low normal, to ever high normal, to transient abnormal, to persistent abnormal (Ptrend |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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