- 學位論文
探討REACH-B分數應用在慢性B型肝炎病人接受抗病毒藥物治療適應症之價值：以2012亞太治療共識為例
Performance of Risk Estimation for Hepatocellular Carcinoma in Chronic Hepatitis B (REACH-B) score in classifying treatment eligibility under 2012 Asian Pacific Association for the Study of the Liver (APASL) guideline for chronic hepatitis B patients
摘要
背景 REACH-B (Risk Estimation for Hepatocellular Carcinoma [HCC] in Chronic Hepatitis B)為評估慢性B型肝炎未來是否發生肝癌的一個有用的計分法。 目的 本研究將探討REACH-B計分表可否應用在慢性B型肝炎病人接受抗病毒藥物治療適應症，並以我們臨床常用的2012亞太治療共識為例 方法 共分析904位慢性B型肝炎患者，詳實記錄病人年紀，性別，肝臟發炎指數，B型肝炎e抗原有無，與B型肝炎病毒量，算出每位患者的REACH-B分數。並進一步研究REACH-B分數與是否合乎2012亞太治療共識建議的慢性B型肝炎病人接受抗病毒藥物治療適應症之間的關聯性。 結果 針對e抗原陽性患者，REACH-B分數與是否合乎2012亞太治療共識建議的慢性B型肝炎病人接受抗病毒藥物治療適應症之間無關(adjusted odds ratio [OR] 1.210, 95% confidence interval [CI] 0.979-1.494, P = 0.078) in HBeAg-positive patients, as shown by logistic regression analysis after adjusting for sex)。針對e抗原陰性患者，REACH-B分數與是否合乎2012亞太治療共識建議的慢性B型肝炎病人接受抗病毒藥物治療適應症之間則有關聯性(adjusted OR 1.783, 95% CI 1.607-1.979, P < 0.001)。以area under receiver operating characteristic (AUC)方法去研究REACH-B分數與是否合乎2012亞太治療共識建議的慢性B型肝炎病人接受抗病毒藥物治療適應症之間的一致性(discriminatory ability of REACH-B score to classify eligibility)，我們發現e抗原陽性且年紀大於40歲患者有最差的一致性 (AUC 0.664, 95% CI 0.533-0.795)。但在e抗原陽性且年紀小於40歲患者(AUC 0.903, 95% CI 0.841-0.964), e抗原陰性且年紀大於45歲患者(AUC 0.883, 95% CI 0.848-0.917)，與e抗原陰性且年紀小於45歲患者(AUC 0.907, 95% CI 0.874-0.940)這三組病人一致性則很高. 結論 REACH-B分數與是否合乎2012亞太治療共識建議的慢性B型肝炎病人接受抗病毒藥物治療適應症之間的一致性很高，但e抗原陽性且年紀大於40歲患者這一族群例外。
並列摘要
Background REACH-B [Risk Estimation for Hepatocellular Carcinoma (HCC) in Chronic Hepatitis B] scoring system was developed to predict the risk of HCC in non-cirrhotic chronic hepatitis B (CHB) patients. Aim To evaluate the discriminatory performance of REACH-B scoring system in classifying anti-viral treatment eligibility of CHB patients according to the 2012 Asian Pacific Association for the Study of the Liver (APASL) treatment guideline. Methods A total of 904 non-cirrhotic CHB were enrolled. Patients’ age, gender, liver biochemistry, HBeAg status and HBV DNA levels were recorded. Results The minimum REACH-B risk score for patients to be eligible for anti-viral treatment was 7 for HBeAg-positive and 6 for HBeAg-negative patients. Among them, increasing REACH-B score was not significantly associated with eligibility for treatment [adjusted odds ratio (OR): 1.210, 95% confidence interval (CI): 0.979–1.494, P = 0.078] in HBeAg-positive patients, as shown by logistic regression analysis after adjusting for gender. In HBeAg-negative patients, REACH-B score significantly predicted the treatment eligibility (adjusted OR: 1.783, 95% CI: 1.607–1.979, P < 0.001). Discriminatory ability of REACH-B score to classify eligibility was poor for HBeAg-positive patients more than 40 years [area under receiver operating characteristic (AUC): 0.664, 95% CI: 0.533–0.795], but good/excellent for HBeAg-positive patients <40 years (AUC: 0.903; 95% CI: 0.841–0.964), HBeAg-negative patients more than 45 years (AUC: 0.883; 95% CI: 0.848–0.917) and HBeAg-negative patients <45 years (AUC: 0.907; 95% CI: 0.874–0.940). Conclusion The discriminatory performance of the REACH-B scoring system in classifying anti-viral treatment eligibility based on the 2012 APASL guideline was good/excellent, except for more than 40 years old HBeAg-positive patients.