Rates and risk factors for hepatitis B reactivation in a cohort of persons in the inactive phase of chronic hepatitis B-Alaska, 2001-2010.
Rates and risk factors for hepatitis B reactivation in a cohort of persons in the inactive phase of chronic hepatitis B-Alaska, 2001-2010.
复制标题
DOI：
10.1016/j.jcv.2013.08.012
复制
发表时间：
2013-10
期刊：
影响因子：
--
通讯作者：
McMahon BJ
中科院分区：
文献类型：
--
作者：
Tohme RA;Bulkow L;Homan CE;Negus S;McMahon BJ
在慢性B型肝炎非活动期的免疫抑制个体中，B型肝炎再激活的患病率较高;然而，在非免疫抑制者中，再激活的比例和风险因素在很大程度上是未知的。在阿拉斯加州慢性B型肝炎非活动期人群队列中估计B型肝炎再激活的发病率和危险因素。对414名处于B型肝炎非活动期的阿拉斯加土著人（HBV DNA < 2000 IU/mL，丙氨酸氨基转移酶（ALT）正常12个月）进行了10年的随访。B型肝炎再激活定义为HBV DNA ≥ 2000 IU/mL且ALT ≥ 40 IU/L。Cox比例风险回归模型用于识别与再激活相关的因素。在2984人-年的随访中，共有36人（9%）再次激活，年发生率为1.2%。入组研究时年龄≥50岁的患者（1.8%）的再激活发生率最高，但各年龄组的发生率无显著差异。B型肝炎再激活的风险因素为男性（风险比（HR）= 2.41; 95%置信区间（CI）：1.17-4.96）、研究入组时HBV DNA ≥ 1000 IU/mL（HR = 7.61; 95% CI：2.81-20.6）和HBV基因型B（HR = 6.08; 95% CI：1.32-28.0）。在10年的随访中，B型肝炎再激活的发生率很低。然而，考虑到再激活的风险高于其对应人群，男性和HBV DNA ≥ 1000 IU/mL的患者需要更频繁地随访。
A high prevalence of reactivation of hepatitis B has been documented among immunosuppressed individuals in the inactive phase of chronic hepatitis B; However, the proportion of and the risk factors for reactivation are largely unknown among non-immunosuppressed persons. Estimate the incidence rate of and risk factors for hepatitis B reactivation in a population-based cohort of persons in the inactive phase of chronic hepatitis B in Alaska. A cohort of 414 Alaska Native Persons in the inactive phase of hepatitis B (HBV DNA < 2000 IU/mL and normal alanine aminotransferase (ALT) for 12 months) was followed-up for 10 years. Reactivation of hepatitis B was defined as HBV DNA ≥ 2000 IU/mL and ALT ≥ 40 IU/L. Cox-proportional hazards regression models were used to identify factors associated with reactivation. A total of 36 (9%) persons had reactivation during 2984 person-years of follow-up, with an annual incidence of 1.2%. Persons aged ≥50 years (1.8%) at study entry had the highest incidence rates of reactivation although incidence rates were not significantly different by age group. Risk factors for hepatitis B reactivation were male sex (Hazard Ratio (HR) = 2.41; 95% Confidence Interval (CI): 1.17–4.96), HBV DNA ≥ 1000 IU/mL at study entry (HR = 7.61; 95% CI: 2.81–20.6), and HBV genotype B (HR = 6.08; 95% CI: 1.32–28.0). The incidence of hepatitis B reactivation was low during the 10 years of follow-up. However, given the higher risk of reactivation than their counterparts, males, and those with HBV DNA ≥ 1000 IU/mL need to be followed-up more frequently.