Long-term natural history of liver disease in patients with chronic hepatitis B virus infection: an analysis using the Markov chain model
Long-term natural history of liver disease in patients with chronic hepatitis B virus infection: an analysis using the Markov chain model
复制标题
慢性乙肝病毒感染患者肝脏疾病的长期自然病史：基于马尔可夫链模型的分析
DOI：
10.1007/s00535-018-1467-x
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发表时间：
2018-11-01
影响因子：
6.3
通讯作者：
Tanaka, Junko
中科院分区：
文献类型：
--
作者：
Tada, Toshifumi;Kumada, Takashi;Tanaka, Junko
背景B e抗原（HBeAg）血清转换与长期肝病自然史之间的关系尚未得到充分研究。方法共纳入408例慢性B病毒（HBV）患者，共4352人年（PY）单位，未接受抗病毒治疗。研究患者分为三组，如下：A组（2666 PY单位），年龄< 40岁时HBeAg血清转换; B组（413 PY单位），年龄≥ 40岁时HBeAg血清转换; C组（1273 PY单位），HBeAg持续阳性。使用马尔科夫链模型计算每个肝脏状态[慢性乙型肝炎病毒感染、慢性B肝炎、肝硬化、肝细胞癌（HCC）和B肝炎表面抗原（HBsAg）阴性]的年度转移概率。结果在1年肝脏疾病状态转移概率分析中，A组的肝脏状态几乎保持不变。在B和C组中，每种肝脏状态都有恶化的趋势。假设40岁时的慢性B型肝炎状态作为接下来40年的模拟的起始条件，在A组中，慢性B型肝炎状态约占50岁以上男性的60%，约占60岁以上女性的40%，HBsAg阴性状态约占60岁以上男性和女性的30-40%。B、C组中，肝硬化和HCC的发生率随年龄的增长而逐渐增加。结论HBeAg持续阳性者和HBeAg血清转换延迟者的肝脏相关自然史预后均较差。
Background The relationship between the hepatitis B e antigen (HBeAg) seroconversion and the long-term natural history of liver disease has not been sufficiently investigated.Methods A total of 408 [4352 person-year (PY) units] patients with chronic hepatitis B virus (HBV) without antiviral therapy were enrolled. The study patients were divided into three groups, as follows: Group A (2666 PY units), seroconverted of HBeAg at age < 40; Group B (413 PY units), seroconverted of HBeAg at age >= 40; Group C (1273 PY units), persistently HBeAg positive. Yearly transition probabilities from each liver state [chronic HBV infection, chronic hepatitis B, cirrhosis, hepatocellular carcinoma (HCC), and hepatitis B surface antigen (HBsAg) negativity] were calculated using the Markov chain model.Results In the analysis of 1 year liver disease state transition probabilities, the liver states remained almost the same in Group A. In Groups B and C, each liver state tended to progress to a worse state. Assuming a chronic hepatitis B state at age 40 as the starting condition for simulation over the next 40 years, the chronic hepatitis B state accounted for approximately 60% of males aged >= 50 and approximately 40% of females aged >= 60 in Group A, and the HBsAg-negative state accounted for approximately 30-40% of males and females aged >= 60. In Groups B and C, the probabilities of patients with cirrhosis and HCC gradually increased with age.Conclusions Not only patients with persistent HBeAg positive, but also patients with delayed HBeAg seroconversion showed poor prognosis of liver-related natural history.