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World Journal of Clinical Cases 2024年第22期12卷 5177-5183页

作者： Kyeong-Hoon Park Jeong-Ju Yoo sang gyune kim Young Seok kim Department of Gastroenterology and Hepatology Soonchunhyang University School of MedicineBucheon 14584South Korea

BACKGROUND Atezolizumab/bevacizumab is emerging as the new standard for advanced hepatocellular carcinoma(HCC),with ongoing real-world implementation to study its *** the use of atezolizumab/bevacizumab increases,various side effects have been reported in clinical practice,most notably increased bleeding caused by *** SUMMARY In this case report,we present a rare and fatal case of intratumoral hemorrhage in a patient with advanced HCC following successful treatment with atezolizumab/bevacizumab.A 63-year-old male diagnosed with HCC initially underwent four cycles of intra-arterial ***,follow-up abdominal computed tomography(CT)revealed disease ***,the treatment plan was modified to atezolizumab/*** the fifth cycle of atezolizumab/bevacizumab,CT showed partial regression of *** week later,he visited the emergency room due to severe abrupt abdominal *** CT revealed focal rupture of HCC in the medial segment inferior portion with active bleeding and a large amount of *** was performed on the same day,and embolization of A4 and A8 branches using lipiodol and gelfoam was *** successful hemostasis,the patient subsequently developed liver failure and *** Atezolizumab/bevacizumab for advanced HCC suggests that intratumoral hemorrhage may be crucial despite good tumor response after immunotherapy,emphasizing the continuous monitoring of this side effect.

关键词： Adverse events Atezolizumab Bevacizumab Complication Hemorrhage Bleeding Hepatocellular carcinoma Case report

Extremely rare case of necrotizing gastritis in a patient with autoimmune hepatitis: A case report

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World Journal of Clinical Cases 2021年第14期9卷 3472-3477页

作者： Seung Ki Moon Jeong-Ju Yoo sang gyune kim Young Seok kim Department of Internal Medicine Soonchunhyang University Bucheon HospitalBucheon 14584South Korea Department of Gastroenterology and Hepatology Soonchunhyang University School of MedicineBucheon 14584South Korea

BACKGROUND Autoimmune hepatitis can cause liver fibrosis,liver cirrhosis,and hepatocellular *** treatment option include the use of steroids and/or immunesuppressive agents such as ***,these drugs have some side ***,close follow-up is needed during ***,we present an extremely rare case of a patient with an autoimmune hepatitis who died from necrotizing gastritis during immunosuppressive *** SUMMARY A 52-year-old female patient was diagnosed with autoimmune *** treated this patient with immunosuppressive ***-dose steroid treatment was initially *** azathioprine treatment was added while steroid was *** weeks after the start of treatment,she visited the emergency room due to generalized abdominal pain and *** computed tomography scan,the patient was diagnosed with necrotizing gastritis and the patient progressed to septic *** for sepsis was continued in the intensive care ***,the patient died at 6 h after admission to the emergency *** In patients with autoimmune infections undergoing immunosuppressant therapy,rare complications such as necrotizing gastritis may occur,thus requiring clinical attention.

关键词： Autoimmune hepatitis Azathioprine Case report

Rare case of hepatocellular carcinoma metastasis to urinary bladder:A case report

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World Journal of Clinical Cases 2022年第16期10卷 5470-5478页

作者： Yohan kim Young Seok kim Jeong-Ju Yoo sang gyune kim Susie Chin Ahrim Moon Department of Gastroenterology Soonchunhyang University Hospital BucheonBucheon B14200202Gyeonggi-doSouth Korea Division of Gastroenterology and Hepatology Department of Internal MedicineSoonchunhyang University Bucheon HospitalBucheon B14200202Gyeonggi-doSouth Korea Department of Pathology Soonchunhyang University Bucheon HospitalBucheon B14200202Gyeonggi-doSouth Korea Department of Pathology Soonchunhyang University Bucheon HospitalSoonchunhyang University College of MedicineBucheon B14200202Gyeonggi-doSouth Korea

BACKGROUND Hepatocellular carcinoma(HCC)is a primary liver cancer with high prevalence and *** are many cases of advanced HCC at the time of *** methods and prognosis are different depends on whether metastasis is ***,it is necessary to make an accurate evaluation at the time of *** metastases of HCC usually occur through hematogenous spread or through adjacent organs such as the *** to the urinary bladder alone is ***,we report a rare case of biopsy-proven solitary metastasis of HCC to the bladder in a 60-year-old *** SUMMARY A 60-year-old female patient was found to be positive for hepatitis B surface antigen by chance after abdominal ultrasonography showed abnormal ***,liver dynamic computed tomography(CT)was *** patient visited the hospital for further *** and CT showed 3.6 cm sized arterial enhancing mass in segment 5 and an infiltrative mass in segment *** patient was diagnosed with HCC through liver dynamic magnetic resonance imaging and liver ***,she underwent two transcatheter arterial chemoembolizations within five months for *** follow-up,a newly appeared bladder tumor was found on liver dynamic *** underwent transurethral resection of the bladder tumor for diagnosis and *** tissue was confirmed as metastatic *** Although rare,metastasis to urinary bladder from HCC can occur without evidence of other distant ***,regular follow-up imaging examination and clinical attention are required.

关键词： Hepatocellular carcinoma Metastasis Urinary bladder Case report

Biopsy-confirmed fenofibrate-induced severe jaundice:A case report

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World Journal of Clinical Cases 2021年第30期9卷 9295-9301页

作者： Hye Young Lee Ae-Ra Lee Jeong-Ju Yoo Susie Chin sang gyune kim Young Seok kim Department of Internal Medicine Soonchunhyang University Bucheon HospitalBucheon 14584South Korea Department of Pathology Soonchunhyang University Bucheon HospitalSoonchunhyang University College of MedicineBucheon 14584South Korea

BACKGROUND Drug-induced liver injury(DILI)is the leading cause of acute liver failure in the United *** is mainly caused by painkillers and fever reducers,and it is often characterized by the type of hepatic injury(hepatocellular or cholestatic).This report presents a case of fenofibrate-induced severe jaundice in a 65-year-old Korean male with no prior history of liver *** offer a strategy for patients who present signs of severe liver injury with jaundice and high elevations in serum *** SUMMARY A 65-year-old male visited the gastroenterology outpatient clinic of a tertiary hospital due to increased levels of liver enzyme and total bilirubin which were incidentally detected through a preoperative screening *** ultrasound and computed tomography showed no biliary obstruction or nonspecific findings in the *** biopsy was performed and the patient was finally diagnosed with acute cholestatic *** the biopsy,steroid therapy was initiated and after 3 wk of treatment,the total bilirubin level was reduced to 7.22 mg/*** In patients with hyperlipidemia,treatment including fenofibric acid induces rare complications such as severe jaundice and acute cholestatic hepatitis,warranting clinical attention.

关键词： Drug-induced liver injury Toxic hepatitis Fenofibrate Fenofibric acid Jaundice Hepatotoxicity Hyperlipidemia Case report

Long-term result of endoscopic Histoacryl （N-butyl-2-cyanoacrylate）injection for treatment of gastric varices

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World Journal of Gastroenterology 2011年第11期17卷 1494-1500页

作者： Eun Jung Kang Soung Won Jeong Jae Young Jang Joo Young Cho Sae Hwan Lee Hyun Gun kim sang gyune kim Young Seok kim Young Koog Cheon Young Deok Cho Hong Soo kim Boo Sung kim Institute for Digestive Research Department of Internal MedicineSoonchunhyang University College of MedicineSeoul HospitalSeoul 140-743South Korea

AIM:To evaluate the long-term efficacy and safety of endoscopic obliteration with Histoacryl  for treatment of gastric variceal bleeding and ***:Between January 1994 and March 2010 at SoonChunHyang University Hospital,a total of 127 patients with gastric varices received Histoacryl  injections *** hundred patients underwent endoscopic Histoacryl  injections because of variceal bleeding,the other 27 patients received such injections as a prophylactic ***:According to Sarin classification,56 patients were GOV1,61 patients were GOV2 and 10 patients were *** of the varices were large(F2 or F3,111 patients).The average volume of Histoacryl  per each session was 1.7±1.3 cc and mean number of sessions was 1.3±0.6.(1 session-98 patients,2 sessions-25 patients,≥3 sessions-4 patients).Twenty-seven patients with high risk of bleeding(large or fundal or RCS+or Child C) received Histoacryl  injection as a primary prophylactic *** these patients,hepatitis B virus was the major etiology of cirrhosis,25 patients showed GOV1 or 2(92.6%)and F2 or F3 accounted for 88.9%(n=24).The rate of initial hemostasis was 98.4%and recurrent bleeding within one year occurred in 18.1%of *** hemostasis during episodes of rebleeding was achieved in 73.9%of *** survival was 50 mo (95%CI 30.5-69.5).Major complications occurred in 4 patients(3.1%).The rebleeding rate in patients with hepatocellular carcinoma or GOV2 was higher than in those with other *** of the 27 subjects who were treated prophylactically experienced treatment-related *** survival rates of the 127 patients at 6 mo,1,3,and 5 years were 92.1%,84.2%,64.2%,and 45.3%,*** 6 mo cumulative survival rate of the 27 patients treated prophylactically was 75%.CONCLUSION:Histoacryl  injection therapy is an effective treatment for gastric varices and also an effective prophylactic treatment of gastric varices which

关键词： Gastric varix Prophylaxis Histoacryl  (Nbutyl-2-cyanoacrylate) Histoacryl  injection Treatment of gastric varix

Timing of upper gastrointestinal endoscopy does not influence short-term outcomes in patients with acute variceal bleeding

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World Journal of Gastroenterology 2018年第44期24卷 5025-5033页

作者： Jeong-Ju Yoo Young Chang Eun Ju Cho Ji Eun Moon sang gyune kim Young Seok kim Yun Bin Lee Jeong-Hoon Lee Su Jong Yu Yoon Jun kim Jung-Hwan Yoon Department of Gastroenterology and Hepatology Soonchunhyang University school of Medicine Bucheon 14584 South Korea Department of Internal Medicine and Liver Research Institute Seoul National University College of Medicine Seoul 03080 South Korea Department of Biostatistics Clinical Trial Center Soonchunhyang University Bucheon Hospital Bucheon 14584 South Korea

AIM To examine the association between the timing of endo-scopy and the short-term outcomes of acute variceal bleeding in cirrhotic *** This retrospective study included 274 consecutive patients admitted with acute esophageal variceal bleeding of two tertiary hospitals in Korea. We adjusted confounding factors using the Cox proportional hazards model and the inverse probability weighting （IPW） method. The primary outcome was the mortality of patients within 6 *** A total of 173 patients received urgent endoscopy （ i.e. , ≤ 12 h after admission）, and 101 patients received non-urgent endoscopy （〉 12 h after admission）. The 6-wk mortality rate was 22.5% in the urgent endoscopy group and 29.7% in the non-urgent endoscopy group, and there was no significant difference between the two groups before （P = 0.266） and after IPW （P = 0.639）. The length of hospital stay was statistically different between the urgent group and non-urgent group （P = 0.033）; however, there was no significant difference in the in-hospital mortality rate between the two groups （8.1%vs 7.9%, P = 0.960）. In multivariate analyses, timing of endoscopy was not associated with 6-wk mortality （hazard ratio, 1.297; 95% confdence interval, 0.806-2.089; P = 0.284）.CONCLUSION In cirrhotic patients with acute variceal bleeding, the timing of endoscopy may be independent of short-term mortality.

关键词： Cirrhosis Endoscopy Upper gastrointestinal bleeding Gastroesophageal varices Timing

Assessment of scoring systems for acute-on-chronic liver failure at predicting short-term mortality in patients with alcoholic hepatitis

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World Journal of Gastroenterology 2016年第41期22卷 9205-9213页

作者： Hee Yeon kim Chang Wook kim Tae Yeob kim Do Seon Song Dong Hyun Sinn Eileen L Yoon Young Kul Jung Ki Tae Suk sang Soo Lee Chang Hyeong Lee Tae Hun kim Jeong Han kim Hyung Joon Yim Sung Eun kim Soon Koo Baik Byung Seok Lee Jae Young Jang Young Seok kim sang gyune kim Jin Mo Yang Joo Hyun Sohn Heon Ju Lee Seung Ha Park Eun Hee Choi Dong Joon kim Korean Acute-on-Chronic Liver Failure Study Group Department of Internal Medicine College of MedicineThe Catholic University of KoreaSeoul 06591South Kerea Institute of Medical Science Hanyang UniversitySeoul 04763South Kerea Department of Internal Medicine Samsung Medical CenterSeoul 06351South Kerea Department of Internal Medicine Inje University Sanggye Paik HospitalSeoul 01757South Kerea Department of Internal Medicine Korea University Ansan HospitalAnsan 15355South Korea Department of Internal Medicine Hallym University Chuncheon Sacred Heart HospitalChuncheon 24253South Kerea Department of Internal Medicine Gyeongsang National University HospitalJinju 52727South Kerea Department of Internal Medicine Catholic University of Daegu School of MedicineDaegu 42472South Kerea Department of Internal Medicine Ewha Womans University School of MedicineSeoul 07985South Kerea Department of Internal Medicine Konkuk University School of MedicineSeoul 05030South Kerea Department of Internal Medicine Hallym University Sacred Heart HospitalAnyang 14068South Kerea Department of Internal Medicine Yonsei University Wonju College of MedicineWonju 26426South Kerea Department of Internal Medicine Chungnam National UniversitySchool of MedicineDaejeon 35015South Kerea Department of Internal Medicine Soonchunhyang University College of MedicineSeoul 04401South Kerea Department of Internal Medicine Soonchunhyang University Bucheon HospitalBucheon 14584South Kerea Department of Internal Medicine Hanyang University Guri HospitalGuri 11923South Kerea Department of Internal Medicine Yeungnam University College of MedicineDaegu 42415South Kerea Department of Internal Medicine Inje University Haeundae Paik-HospitalInje University College of MedicineBusan 48108South Kerea Institute of Lifestyle Medicine Yonsei University Wonju College of MedicineWonju 26426South Kerea 不详

AIM To assess the performance of proposed scores specific for acute-on-chronic liver failure in predicting shortterm mortality among patients with alcoholic *** We retrospectively collected data from 264 patients with clinically diagnosed alcoholic hepatitis from January to December 2013 at 21 academic hospitals in Korea. The performance for predicting short-term mortality was calculated for Chronic Liver FailureSequential Organ Failure Assessment(CLIF-SOFA), CLIF Consortium Organ Failure score(CLIF-C OFs), Maddrey'sdiscriminant function(DF), age, bilirubin, international normalized ratio and creatinine score(ABIC), Glasgow Alcoholic Hepatitis Score(GAHS), model for end-stage liver disease(MELD), and *** Of 264 patients, 32(12%) patients died within 28 d. The area under receiver operating characteristic curve of CLIF-SOFA, CLIF-C OFs, DF, ABIC, GAHS, MELD, and MELD-Na was 0.86(0.81-0.90), 0.89(0.84-0.92), 0.79(0.74-0.84), 0.78(0.72-0.83), 0.81(0.76-0.86), 0.83(0.78-0.88), and 0.83(0.78-0.88), respectively, for 28-d mortality. The performance of CLIF-SOFA had no statistically significant differences for 28-d mortality. The performance of CLIF-C OFs was superior to that of DF, ABIC, and GAHS, while comparable to that of MELD and MELD-Na in predicting 28-d mortality. A CLIF-SOFA score of 8 had 78.1% sensitivity and 79.7% specificity, and CLIF-C OFs of 10 had 68.8% sensitivity and 91.4% specificity for predicting 28-d *** CLIF-SOFA and CLIF-C OF scores performed well, with comparable predictive ability for short-term mortality compared to the commonly used scoring systems in patients with alcoholic hepatitis.

关键词： Acute-on-chronic liver failure Alcoholic hepatitis Mortality Prognosis Scoring system

Diagnostic value for extrahepatic metastases of hepatocellular carcinoma in positron emission tomography/computed tomography scan

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World Journal of Gastroenterology 2012年第23期18卷 2979-2987页

作者： Ji Eun Lee Jae Young Jang Soung Won Jeong Sae Hwan Lee sang gyune kim sang-Woo Cha Young Seok kim Young Deok Cho Hong Soo kim Boo Sung kim So Young Jin Deuk Lin Choi Institution for Digestive Research Digestive Disease Center Department of Internal Medicine Soonchunhyang University Hospital Seoul 140-743 South Korea Institution for Digestive Research Digestive Disease Center Department of Internal Medicine Soonchunhyang University Hospital Cheon-an 330-721 South Korea Institution for Digestive Research Digestive Disease Center Department of Internal Medicine Soonchunhyang University Hospital Bu-cheon 420-767 South Korea Department of Pathology Soonchunhyang University Hospital Seoul 140-743 South Korea Department of Radiology Soonchunhyang University Hospital Seoul 140-743 South Korea

AIM: To evaluated the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scan in diagnosis of hepatocellular carcinoma (HCC) and extrahepatic metastases. METHODS: A total of 138 patients with HCC who had both conventional imaging modalities and 18F-FDG PET/CT scan done between November 2006 and March 2011 were enrolled. Diagnostic value of each imaging modality for detection of extrahepatic metastases was evaluated. Clinical factors and tumor characteristics including PET imaging were analyzed as indicative factors for metastases by univariate and multivariate methods. RESULTS: The accuracy of chest CT was significantly superior compared with the accuracy of PET imaging for detecting lung metastases. The detection rate of metastatic pulmonary nodule ≥ 1 cm was 12/13 (92.3%), when < 1 cm was 2/10 (20%) in PET imaging. The accuracy of PET imaging was significantly superior compared with the accuracy of bone scan for detecting bone metastases. In multivariate analy- sis, increased tumor size (≥ 5 cm) (P = 0.042) and increased average standardized uptake value (SUV) uptake (P = 0.028) were predictive factors for extrahepatic metastases. Isometabolic HCC in PET imaging was inversely correlated in multivariate analysis (P = 0.035). According to the receiver operating characteristic curve, the optimal cutoff of average SUV to predict extrahepatic metastases was 3.4. CONCLUSION: 18F-FDG PET/CT scan is invaluable for detection of lung metastases larger than 1 cm and bone metastases. Primary HCC having larger than 5 cm and increased average SUV uptake more than 3.4 should be considered for extrahepatic metastases.

关键词： ^ 18F-fluorodeoxyglucose positron emissiontomography/computed tomography scan Diagnosis Hepatocellular carcinoma ExtrahepaUc metastases

Efficacy of Pegylated Interferon Monotherapy versus Sequential Therapy of Entecavir and Pegylated Interferon in Hepatitis B e Antigen-Positive Hepatitis B Patients： A Randomized, Multicenter, Phase IIIb Open-Label Study （POTENT Study）

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Chinese Medical Journal 2018年第14期131卷 1645-1651页

作者： Dae Won Jun sang Bong Ahn Tae Yeob kim Joo Hyun Sohn sang gyune kim Se Whan Lee Byung Ho kim Dong Joon kim Ja Kyung kim Hyoung Su kim Seong Gyu Hwang Won Choong Choi Won Young Tak Heon Ju Lee Ki Tae Yoon Byung Cheol Yun Sung Wook Lee Soon Koo Baik Seung Ha Park Ji Won Park Sol Ji Park Ji Sung Lee Department of Internal Medicine Hanyang University Seoul Hospital Hanyang University Seou104763 Korea Department of Internal Medicine Nowon Eulji Hospital Eulji University Seou101830 Korea Department of Internal Medicine Hanyang University Guri Hospital Hanyang University Guri 11923 Korea Department of Internal Medicine SoonChunHyang University Bucheon Hospital SoonChunHyang University Bucheon 14584 Korea Department of Internal Medicine SoonChunHyang University Cheonan Hospital SoonChunHyang University Cheonan 31151 Korea Department of Internal Medicine Kyung Hee University Hospital Kyung Hee University Seoul 02453 Korea Department of Internal Medicine Chuncheon Sacred Heart Hospital Hallym University Chuncheon 24252 Korea Department of Internal Medicine Kangdong Sacred Heart Hospital Hallym University Seou105355 Korea Department of Internal Medicine Gangnam Severance Hospital Yonsei University Seou106273 Korea Department of Internal Medicine CHA Bundang Medical Center CHA University Seongnam 13496 Korea Department of Internal Medicine Sanggye Paik Hospital Inje University Seoul 01757 Korea Department of Internal Medicine Kyungpook National University Hospital Kyungpook National University Daegu 41944 Korea Department of Internal Medicine Yeungnam University Medical Center Yeungnam University Daegu 42415 Korea Department of Internal Medicine Pusan National University Yangsan Hospital Pusan National University Yangsan 50612 Korea Department of Internal Medicine Kosin University Gospel Hospital Kosin University Pusan 49267 Korea Department of Internal Medicine Dong A University Medical Center Dong A University Pusan 49201 Korea Department of Internal Medicine Wonju Severance Christian Hospital Yonsei University Wonju 26426 Korea Department of Internal Medicine Haeundae Paik Hospital Inje University Pusan 48108 Korea Department of Internal Medicine Hallym University Sacred Heart Hospital Hallym University Anyang 14068 Korea Department of Cli

Background： Until now, various types of combined therapy with nucleotide analogs and pegylated interferon （Peg-INF） in patients with hepatitis B patients have been tried. Howe6ver, studies regarding the benefits of de novo combination, late-add on, and sequential treatmentare very limited. The objective of the current study was to identify the efficacy of sequential treatment of Peg-INF after short-term antiviral treatment. Methods： Between June 2010 and June 2015, hepatitis 13 e antigen （HBeAg）-positive patients （n = 162） received Peg-IFN for 48 weeks （mono-treatment group, n = 81） and entecavir （ETV） for 12 weeks with a 48-week course of Peg-IFN starting at week 5 of ETV therapy （sequential treatment group, n = 81）. The primary endpoint was HBeAg seroconversion at the end of follow-up period after the 24-week treatment. The primary endpoint was analyzed using Chi-square test, Fisher＇s exact test, and regression ***： HBeAg seroconversion rate （18.2% vs. 18.2%, t = 0.03, P = 1.000） and seroclearance rate （19.7% vs. 19.7%, t = 0.03, P = 1.000） were same in both mono-treatment and sequential treatment groups. The rate of alanine aminotransferase （ALT） normalization （45.5% vs. 54.5%, t = 1.12, P = 0.296） and serum hepatitis B virus （HBV）-DNA 〈2000 U/L （28.8% vs. 28.8%, t = 0.10, P = 1.000） was not different in sequential and mono-treatment groups at 24 weeks of Peg-INF. Viral response rate （HBeAg seroconversion and serum HBV-DNA 〈2000 U/L） was not different in the two groups （12.1% vs. 16.7%, t = 1.83, P = 0.457）. Baseline HBV-DNA level （7 log10 U/ml vs. 7.5 log10 U/ml, t = 1.70, P = 0.019） and hepatitis B surface antigen titer （3.6 log10 U/ml vs. 4.0 log10 U/ml, t = 2.19, P = 0.020） were lower and predictors of responder in mono-treatment and sequential treatment groups, respectively. Conclusions： The current study shows no differences in HBeAg seroconversion rate, ALT normalization, and HBV-DNA levels between mono-therapy and sequential therapy regimens.

关键词： Entecavir Hepatitis B Peginterferon Alfa-2a

Management of entecavir-resistant chronic hepatitis B with adefovir-based combination therapies

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World Journal of Gastroenterology 2015年第38期21卷 10874-10882页

作者： Hyoung Su kim Hyung Joon Yim 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 Department of Internal Medicine Hallym University College of Medicine Department of Internal Medicine Korea University Ansan Hospital Department of Internal Medicine Korea University Medical College Department of Internal Medicine Bundang Jesaeng Hospital Department of Internal Medicine Soon Chun Hyang University College of Medicine Department of Internal Medicine Inha University School of Medicine Department of Internal Medicine Chonbuk National University Medical School Department of Internal Medicine Hanyang University College of Medicine Department of Internal Medicine Seoul National University College of Medicine Department of Internal Medicine Gachon University School of Medicine Department of Internal Medicine CHA Bundang Medical CenterCHA University

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,***: 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 ***: If tenof

关键词： Adefovir Chronic hepatitis B Entecavir Lamivudine