Hepatitis B Virus Reactivation Increased the Risk of Developing Hepatic Failure and Mortality in Cirrhosis With Acute Exacerbation.
Hepatitis B Virus Reactivation Increased the Risk of Developing Hepatic Failure and Mortality in Cirrhosis With Acute Exacerbation.
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乙型肝炎病毒重新激活会增加肝硬化急性加重时发生肝衰竭和死亡的风险
DOI：
10.3389/fmicb.2022.910549
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发表时间：
2022
影响因子：
5.2
通讯作者：
中科院分区：
文献类型：
--
作者：
乙肝病毒（HBV）再激活是一种严重的病症，在接受化疗的免疫抑制人群中已有大量相关描述。然而，对于免疫功能正常的慢性乙型肝炎（CHB）患者中HBV再激活的情况，人们知之甚少。在本研究中，我们评估了CHB急性加重患者中HBV再激活的发生率及其临床意义。
患者来自两项前瞻性多中心观察队列（CATCH - LIFE队列）的筛选。总共纳入了1020例有抗病毒治疗史的CHB患者，以评估HBV再激活的发生率、危险因素、临床特征及其对慢性肝病进展的影响。
在我们的研究中，有抗病毒治疗史的CHB急性加重患者中，HBV再激活的发生率为51.9%。在529例HBV再激活患者中，70.9%是由停用抗病毒治疗引发，5.9%是由核苷（酸）类似物（NUCs）耐药引发。HBV再激活患者中抗病毒治疗中断和NUCs耐药的发生率远高于未发生再激活的患者（分别为70.9% 对比0.2%，5.9% 对比0，两者p均<0.001）。分层和交互分析显示，在肝硬化亚组中，HBV再激活与短期高死亡率相关（风险比[HR]=2.1，p<0.001）。发生HBV再激活的肝硬化患者发生肝衰竭（45.0% 对比20.3%，p<0.001）、慢加急性肝衰竭（ACLF；31.4% 对比21.8%，p = 0.005）以及短期死亡（28天死亡率14.0% 对比5.9%，90天死亡率23.3% 对比12.4%，两者p均<0.001）的比例显著高于未发生再激活的患者。HBV再激活是肝硬化患者90天死亡率的独立危险因素（比值比[OR]=1.70，p = 0.005），同时也是肝性脑病、腹水和细菌感染的独立危险因素。
本研究明确表明，CHB患者中HBV再激活的发生率较高，主要由停用抗病毒治疗引发。HBV再激活显著增加了乙肝相关肝硬化患者发生肝衰竭、ACLF和短期死亡的风险，这可能意味着HBV再激活将成为实现世界卫生组织提出的到2030年将乙肝死亡率降低65%这一目标的新挑战。
Hepatitis B virus (HBV) reactivation is a serious condition and has been extensively described in chemotherapeutic immunosuppressive population. However, little is known about HBV reactivation in immunocompetent patients with chronic hepatitis B (CHB). In this study, we evaluated the prevalence and the clinical significance of HBV reactivation in CHB patients with acute exacerbations. Patients were screened from two prospective multicenter observational cohorts (CATCH-LIFE cohort). A total of 1,020 CHB patients with previous antiviral treatment history were included to assess the prevalence, risk factors, clinical characteristics of HBV reactivation, and its influence on the progression of chronic liver disease. The prevalence of HBV reactivation was 51.9% in CHB patients with acute exacerbations who had antiviral treatment history in our study. Among the 529 patients with HBV reactivation, 70.9% of them were triggered by discontinued antiviral treatment and 5.9% by nucleos(t)ide analogs (NUCs) resistance. The prevalence of antiviral treatment disruption and NUCs resistance in patients with HBV reactivation is much higher than that in the patients without (70.9% vs. 0.2%, and 5.9% vs. 0, respectively, both p < 0.001). Stratified and interaction analysis showed that HBV reactivation was correlated with high short-term mortality in cirrhosis subgroup (HR = 2.1, p < 0.001). Cirrhotic patients with HBV reactivation had a significantly higher proportion of developing hepatic failure (45.0% vs. 20.3%, p < 0.001), acute-on-chronic liver failure (ACLF; 31.4% vs. 21.8%, p = 0.005), and short-term death (14.0% vs. 5.9% for 28-day, and 23.3% vs. 12.4% for 90-day, both p < 0.001) than those without. HBV reactivation is an independent risk factor of 90-day mortality for cirrhosis patients (OR = 1.70, p = 0.005), as well as hepatic encephalopathy, ascites, and bacterial infection. This study clearly demonstrated that there was a high prevalence of HBV reactivation in CHB patients, which was mainly triggered by discontinued antiviral treatment. The HBV reactivation strongly increased the risk of developing hepatic failure, ACLF and short-term death in HBV-related cirrhotic patients, which may suggest that HBV reactivation would be a new challenge in achieving the WHO target of 65% reduction in mortality from hepatitis B by 2030.
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影响因子：
24.5
作者：
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