The long-term course of chronic hepatitis B
The long-term course of chronic hepatitis B
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DOI：
10.1002/hep.510300109
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发表时间：
1999-07-01
期刊：
影响因子：
13.5
通讯作者：
Craxì, A
中科院分区：
文献类型：
--
作者：
Di Marco, V;Lo Iacono, O;Craxì, A
这项研究的目的是根据乙肝病毒、丙型肝炎病毒和丁型肝炎病毒的复制情况，评估乙肝病毒感染患者的长期结局，重点是生存、肝功能衰竭和肝细胞癌。前瞻性评估了302名乙肝表面抗原(HBs)阳性的受试者(平均年龄34+/-15.3岁；男性/女性214/88；39名14岁以下的受试者)，经活检证实的慢性肝炎(86例合并肝硬变)，平均随访时间为94+/-37.6个月。109例患者接受α-干扰素治疗。基线时，86例(28.5%)HBe抗原(HBeAg)阳性(野生型)，80例(26.5%)HBeAg阴性，HBVDNA阳性，76例(25.2%)HDV感染，43例(14.2%)HBVHCV双重感染，17例(5.6%)HBVDNA、抗-HCV和抗-HDV阴性。在随访期间，46名受试者发生了疾病失代偿：8名发展为肝细胞癌，36名发展为腹水，2名发展为黄疸。5例患者接受了移植。35名受试者死亡：33人死于肝病，2人死于非肝病。总体死亡率是普通人群的5.2倍(95%可信区间：3.6-7.3；观察到35例死亡，预期为6.7例；P<；0.0001)，经Cox回归分析，年龄小、基线时无肝硬变、随访期间转氨酶持续正常化是独立预测生存的因素。同样的因素和干扰素治疗可以独立预测无代偿功能障碍的存活率。与我们地区的普通人群相比，慢性乙肝感染会增加死亡率，而不考虑出现时的特定病毒学特征。肝硬变和持续性坏死性炎症的存在显著增加了死亡风险。
The aim of this study was to assess the long-term outcome in hepatitis B virus (HBV)-infected patients according to HBV, hepatitis C virus (HCV), and hepatitis D virus (HDV) replication, focusing on survival, liver failure, and hepatocellular carcinoma (HCC). A cohort of 302 hepatitis B surface antigen (HBsAg)-positive subjects (mean age, 34 +/- 15.3 years; male/female 214/88; 39 subjects under 14 years) with biopsy-proven chronic hepatitis (86 with cirrhosis) was prospectively assessed, with a median follow-up of 94 +/- 37.6 months. One hundred nine patients received interferon alfa (IFN). At baseline, 86 subjects (28.5%) were hepatitis B e antigen (HBeAg)-positive (wild-type HBV), 80 (26.5%) were HBeAg-negative, HBV-DNA-positive, 76 (25.2%) had HDV infection, 43 (14.2%) had dual HBV/HCV infection, and 17 (5.6%) were negative for HBV-DNA, anti-HCV and anti-HDV. During follow-up, decompensation of disease occurred in 46 subjects: 8 developed HCC, 36 developed ascites, and 2 developed jaundice. Five patients underwent transplantation. Thirty-five subjects died: 33 of hepatic and 2 of nonhepatic causes. Overall mortality was 5.2-fold that of the general population (95% CI: 3.6-7.3; 35 deaths observed, 6.7 expected; P < .0001), By Cox regression analysis, survival was independently predicted by young age, absence of cirrhosis at baseline, and sustained normalization of aminotransferases during follow-up. Survival without decompensation was independently predicted by the same factors and by IFN treatment. Chronic hepatitis B infection increases mortality in comparison with the general population in our area regardless of specific virological profiles at presentation. Presence of cirrhosis and persistent necroinflammation markedly increase the risk of death.