Outcome of anti-HBe positive chronic hepatitis B in alpha-interferon treated and untreated patients: a long term cohort study
Outcome of anti-HBe positive chronic hepatitis B in alpha-interferon treated and untreated patients: a long term cohort study
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DOI：
10.1016/s0168-8278(01)00266-5
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发表时间：
2002-02-01
影响因子：
25.7
通讯作者：
Bonino, F
中科院分区：
文献类型：
--
作者：
Brunetto, MR;Oliveri, F;Bonino, F
背景/目标：我们研究了164（103治疗）连续患者，前瞻性随访平均6年（21个月-12 years）的生化和病毒学模式和干扰素对抗-HBe阳性慢性乙型肝炎B的结果的影响。方法：组织学，生化和病毒学特征每月监测在第一个12个月的后续行动。此后，患者分别每4个月和6个月进行一次血液和临床对照。在基线慢性肝炎或肝硬化患者中，随访组织学检查时的肝硬化或肝硬化终末期并发症分别作为影响疾病进展因素分析的终点。疾病进展与年龄较大有关多因素分析显示，无HBeAg史（P = 0.017）、血清HBV-DNA水平较高（P = 0.009）（在慢性肝病中更常见，P = 0.012）是HBV感染的主要危险因素。IgM抗-HBc水平的波动（与疾病加重相关，P = 0.045）与糖尿病患者的终末期并发症相关（P = 0.011）。治疗组和未治疗组的疾病改善率分别为14.6%和1.6%（P = 0.015）：干扰素延缓了疾病进展（P <0.001.Conclusions：抗-HBe阳性慢性B型肝炎患者的预后分别因年龄增大、慢性肝炎患者持续病毒复制或肝炎加重而恶化。干扰素可减少2.5倍的疾病进展。(C)2002年欧洲肝脏研究协会。由Elsevier Science B. V.出版，版权所有。
Background/Aims: We studied the influence of biochemical and virologic patterns and interferon on the outcome of anti-HBe positive chronic hepatitis B in 164 (103 treated) consecutive patients, followed-up prospectively for a mean of 6 years (21 months-12 years).Methods: Histology, biochemical and virologic profiles were characterized by monthly monitoring during the first 12 months of follow-up. Thereafter patients underwent blood and clinical controls every 4 and 6 months, respectively. Cirrhosis at follow-up histology or end stage complications of cirrhosis served as end points for the analysis of factors influencing disease progression in patients with baseline chronic hepatitis or cirrhosis, respectively.Results: Disease progression was associated with older age (P < 0.001), absence of previous HBeAg history (P = 0.017) and higher serum HBV-DNA levels (P = 0.009) (more frequently observed in unremitting disease profile, P = 0.012) at multivariate analysis. Fluctuations of IgM anti-HBc levels (associated with disease exacerbations, P = 0.045) correlated with end stage complications in cirrhotics (P = 0.011). Disease improved in 14.6 and 1.6% of treated and untreated patients, respectively (P = 0.015): interferon slowed disease progression (P < 0.001).Conclusions: The outcome of anti-HBe positive chronic hepatitis B is worsened by older age and persistent viral replication or hepatitis exacerbations in chronic hepatitis or in cirrhotic patients, respectively. Interferon reduces by 2.5-folds disease progression. (C) 2002 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.