Hepatitis B Virus Genotype C Is Associated With More Severe Liver Fibrosis Than Genotype B
Hepatitis B Virus Genotype C Is Associated With More Severe Liver Fibrosis Than Genotype B
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DOI：
10.1016/j.cgh.2009.08.004
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发表时间：
2009-12-01
影响因子：
12.6
通讯作者：
Wong, Vincent Wai-Sun
中科院分区：
文献类型：
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作者：
Chan, Henry Lik-Yuen;Wong, Grace Lai-Hung;Wong, Vincent Wai-Sun
背景与目的：肝纤维化的组织学分析受到样本量小和主要来自活动性肝炎患者的样本的限制。方法：我们对未接受治疗的慢性乙型肝炎患者进行了一项前瞻性研究，以研究乙型肝炎病毒（HBV）基因型与肝纤维化之间的关系。一种经过验证的肝硬度测量算法用于定义不明显纤维化和晚期纤维化。结果：在1106例患者中，711例（64%）年龄大于40岁，370例（34%）乙型肝炎e抗原（HBeAg）休息结果阳性，386例（35%）血清丙氨酸转氨酶水平升高。其中524例（49%）为B基因型，582例（51%）为C基因型。基因型C感染的患者比基因型B感染的患者发生不明显纤维化的频率更低（42%对55%，P < 0.0001），而晚期纤维化的频率更高（25%对19%，P = 0.015）。两种HBV基因型之间肝纤维化严重程度的差异在年龄大于40岁的患者和HBeAg检测阴性的患者中最为明显。基因型C感染者的平均年龄大于基因型B感染者的平均年龄（41岁vs 36岁）。在年龄大于40岁且HBeAg检测呈阴性的患者中，基因型C感染的HBV DNA和丙氨酸转氨酶水平高于基因型B感染的HBV。结论：基因型C型HBV比基因型B型HBV与更严重的肝纤维化相关，可能是因为HBeAg血清转化延迟和活动性疾病延长。
BACKGROUND & AIMS: Histologic analyses of liver fibrosis have been limited by small sample sizes and the predominance of samples from patients with active hepatitis. METHODS: We performed a prospective study of transient elastography in treatment-naive patients with chronic hepatitis B, to investigate the relationship between hepatitis B virus (HBV) genotype and liver fibrosis. A validated liver stiffness measurement algorithm was used to define insignificant fibrosis and advanced fibrosis. RESULTS: Of 1106 patients, 711 (64%) were older than age 40, 370 (34%) had positive rest results for hepatitis B e antigen (HBeAg), and 386 (35%) had increased serum levels of alanine aminotransferase. Of the patients, 524 (49%) had genotype B and 582 (51%) had genotype C HBV infection. Patients with genotype C infection had insignificant fibrosis less often (42% vs 55%; P < .0001) and advanced fibrosis more often (25% vs 19%; P = .015) than those infected with genotype B HBV. The difference in the severity of liver fibrosis between the 2 HBV genotypes was most marked among patients older than age 40 and those who tested negative for HBeAg. The mean age of patients infected by genotype C was greater than that of patients infected by genotype B HBV (41 vs 36 y). Among patients who were older than age 40 and tested negative for HBeAg, those with genotype C infection had higher levels of HBV DNA and alanine aminotransferase than those with genotype B HBV. CONCLUSIONS: Genotype C HBV was associated with more severe liver fibrosis than genotype B HBV, probably because of delayed HBeAg seroconversion and prolonged active disease.