Relationship Between Level of Hepatitis B Virus DNA and Liver Disease: A Population-based Study of Hepatitis B e Antigen-Negative Persons With Hepatitis B
Relationship Between Level of Hepatitis B Virus DNA and Liver Disease: A Population-based Study of Hepatitis B e Antigen-Negative Persons With Hepatitis B
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DOI：
10.1016/j.cgh.2013.09.005
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发表时间：
2014-04-01
影响因子：
12.6
通讯作者：
Livingston, Stephen E.
中科院分区：
文献类型：
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作者：
McMahon, Brian J.;Bulkow, Lisa;Livingston, Stephen E.
背景与目的：关于慢性B型肝炎病毒（HBV）感染者中活动性肝炎的比例的信息很少。我们的目的是确定比例的人与肝炎B e抗原阴性的慢性HBV感染谁开发免疫活性HBV感染随着时间的推移和人口和病毒因素之间的关系对疾病的严重程度肝biopsization.METHODS：我们进行了纵向人口为基础的队列研究754阿拉斯加本地慢性HBV感染患者。每6个月测量一次丙氨酸氨基转移酶（ALT）水平，并在研究入组时和ALT水平超过正常上限（ULN）时测量HBV DNA水平。免疫活性慢性HBV感染定义为2001-2008年1个或多个时间点的ALT水平男性>= 30 U/L，女性> 20 U/L，HBV DNA水平> 2000 IU/mL。肝活检进行了评分，使用修改后的组织学活动指数评分的Knodell和Ishak纤维化score.Results：的研究参与者，186（25%）符合免疫活性HBV的标准，这些最初的56%和44%的后续。在38例有肝活检结果的患者中，16例中只有1例ALT水平始终低于ULN的两倍，19例中有1例HBV DNA在2000 - 20，000 IU/mL之间，而22例中有12例（55%）ALT > ULN的两倍（P = 0.002），18例中有11例（61%）有1个或多个HBV DNA测量值> 20，000 IU/mL（P <0.001），有中度或重度肝炎或纤维化。结论：在一组慢性HBV感染的阿拉斯加原住民中，25%符合免疫活性HBV的标准。如果HBV DNA水平从未超过20，000 IU/mL，则晚期纤维化的可能性较低。
BACKGROUND & AIMS: There is little information on the proportion of persons with chronic hepatitis B virus (HBV) infection with active hepatitis. We aimed to determine the proportion of persons with hepatitis B e antigen-negative chronic HBV infection who develop immune-active HBV infection over time and the relationship between demographic and viral factors on severity of disease on liver biopsy.METHODS: We performed a longitudinal population-based cohort study of 754 Alaska Native patients with chronic HBV infection. Levels of alanine aminotransferase (ALT) were measured every 6 months, and levels of HBV DNA were measured at study entry and whenever ALT levels exceeded the upper limit of normal (ULN). Immune-active chronic HBV infection was defined as levels of ALT >= 30 U/L in men and > 20 U/L in women and levels of HBV DNA > 2000 IU/mL at 1 or more time points from 2001-2008. Liver biopsies were scored by using the modified histology activity index score of Knodell and the Ishak fibrosis score.RESULTS: Of the study participants, 186 (25%) met the criteria for immune-active HBV, 56% of these initially and 44% later during follow up. Of the 38 patients with liver biopsy results, only 1 of 16 with ALT levels consistently below twice the ULN and 1 of 19 with HBV DNA between 2000 and 20,000 IU/mL, vs 12 of 22 (55%) with ALT > twice ULN (P = .002) and 11 of 18 (61%) with 1 or more measurements of HBV DNA > 20,000 IU/mL (P < .001), had moderate or severe hepatitis or fibrosis.CONCLUSIONS: In a cohort of Alaska Natives with chronic HBV infection, 25% met criteria for immune-active HBV. There is a low probability of advanced fibrosis if levels of HBV DNA never exceed 20,000 IU/mL.