Hepatitis B Virus DNA Level Predicts Hepatic Decompensation in Patients With Acute Exacerbation of Chronic Hepatitis B
Hepatitis B Virus DNA Level Predicts Hepatic Decompensation in Patients With Acute Exacerbation of Chronic Hepatitis B
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DOI：
10.1016/j.cgh.2010.02.023
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发表时间：
2010-06-01
影响因子：
12.6
通讯作者：
Liaw, Yun-Fan
中科院分区：
文献类型：
--
作者：
Jeng, Wen-Juei;Sheen, I-Shyan;Liaw, Yun-Fan
背景与目的：慢性B型肝炎病毒（HBV）感染的急性加重可导致肝功能失代偿。确定加重期间预测肝功能失代偿发展的因素非常重要，以便可以立即开始抗病毒治疗。急性加重，定义为丙氨酸氨基转移酶（ALT）水平突然升高至正常上限的5倍以上，在110例B e抗原（HBeAg）血清阳性的非乙型肝炎患者中发生（138次发作）每1 - 2周监测患者的血清ALT、胆红素、白蛋白和凝血酶原水平，性别、年龄、HBV基因型、ALT水平、HBV病毒载量，及其成因多因素logistic回归分析包括急性发作的自发或抗病毒治疗后复发。血清HBV DNA水平的关闭值，以确定处于失代偿风险的患者。138次急性加重中有7次（5.1%）导致肝功能失代偿，血清HBVDNA水平是唯一显著的危险因素（P = 0.03），受试者工作特征曲线下面积为88.6%（P <0.01），血清HBVDNA临界值为1.55 × 10（9）拷贝/mL预测失代偿的敏感性为85 7%，特异性为85 5%，阴性预测值为99 1%，阳性预测值为2 4 0%。结论：在HBeAg阳性的慢性B型肝炎急性加重期，血清HBV DNA的临界值为1.5 5 × 10 9拷贝/mL可用于鉴别需要立即抗病毒治疗的患者。
BACKGROUND & AIMS: Acute exacerbations of chronic hepatitis B virus (HBV) infection can lead to hepatic decompensation It is important to identify factors that predict the development of hepatic decompensation during exacerbation so that antiviral therapy can be initiated immediately METHODS: Acute exacerbation, defined by an abrupt increase in alanine aminotransferase (ALT) levels to >5-fold the upper limit of normal, occurred in 110 hepatitis B e antigen (HBeAg)-seropositive non-cirrhotic patients (138 episodes) The patients were monitored every 1 to 2 weeks for serum levels of ALT, bilirubin, albumin, and prothrombin Sex, age, HBV genotype, ALT level, HBV viral load, and the causes (spontaneous or relapse from antiviral treatment) of exacerbation were included in multivariate logistic regression analyses The receiver operating characteristic curve was used to identify the optimal cut-off value of serum HBV DNA level to identify patients at risk for decompensation RESULTS: Seven of the 138 episodes of acute exacerbation (5 1%) resulted in hepatic decompensation, serum HBV DNA level was the only significant risk factor (P = 003) The area under the receiver operating characteristic curve was 88 6% (P < 001) A serum HBV DNA cut-off value of 1 55 X 10(9) copies/mL predicted decompensation with a sensitivity of 85 7%, a specificity of 85 5%, a negative prediction value of 99 1%, and positive prediction value of 24 0% CONCLUSIONS: During acute exacerbation of HBeAg-positive chronic hepatitis B, a serum HBV DNA cut-off value of 1.55 x 10(9) copies/mL can be used to identify patients in need of immediate antiviral therapy.