FIBROSIS PROGRESSION IN INACTIVE HEPATITIS B VIRUS CARRIERS: A LONGITUDINAL STUDY WITH PAIRED LIVER STIFFNESS MEASUREMENTS
V.W.-S. Wong*, G.L.-H. Wong, Z. Yu, S.H.-T. Chu, H.-Y. Chan, C.-H. Tse, H.L.-Y. Chan
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China. *[email protected]
Background and aims: The European Association for the Study of the Liver (EASL) defines inactive hepatitis B virus (HBV) carriers based on HBV DNA and alanine aminotransferase (ALT) levels. This study aimed to evaluate the risk of disease progression in such patients.
Methods: 417 patients with negative hepatitis B e antigen (HBeAg), HBV DNA < 20,000 IU/ml and normal ALT at baseline underwent liver stiffness measurement (LSM) by Fibroscan in 2006-2008 and again in 2010-2012. Fibrosis progression was defined as increase in LSM by 30% or more and an absolute LSM suggestive of advanced fibrosis at the second assessment.
Results: At baseline, the mean age was 49±11 years, 53% were males, ALT was 29±11 IU/l, HBV DNA was 2.7±0.9 log IU/ml, hepatitis B surface antigen (HBsAg) was 2.5 ±1.4 log IU/ml, and LSM was 6.4±3.2 kPa. 56 (13.4%) patients had advanced fibrosis at baseline. At an interval of 44±7 months, 10 of 361(2.8%) patients without advanced fibrosis at baseline developed fibrosis progression and 49 (13.6%) required antiviral therapy. Among 244 patients with baseline HBV DNA < 2,000 IU/ml, 11.9% had HBV DNA ≥20,000 IU/ml during follow-up, 8.2% required antiviral therapy and 2.9% had fibrosis progression. Corresponding figures in 117 patients with baseline HBV DNA 2,000-20,000 IU/ml were 16.4%, 24.8% and 2.6%, respectively (P< 0.001, < 0.001 and =0.76, respectively). The addition of HBsAg level to HBV DNA did not improve the prediction of outcomes.
Conclusions: Among patients with negative HBeAg and normal ALT, those with HBV DNA 2,000-20,000 IU/ml had similarly low risk of fibrosis progression but were more likely to develop indications for treatment than those with HBV DNA < 2,000 IU/ml.
Acknowledgements: This study was supported by the Research Fund for the Control of Infectious Diseases of the Hong Kong SAR Government (Ref 11100372).
Assigned speakers:
Dr. Vincent Wong, The Chinese University of Hong Kong , Hong Kong , China
Assigned in sessions:
25.04.2013, 09:00-18:00, Poster Session, P01-07b, Category 07b: Viral Hepatitis B & D: Clinical (except therapy), Poster Area
作者: StephenW 时间: 2013-4-16 19:35
背景和目的:欧洲肝脏研究协会(EASL)定义无效乙型肝炎病毒(HBV)携带者根据HBV DNA和丙氨酸氨基转移酶(ALT)水平。本研究旨在评估在这些患者的疾病进展风险。
方法:417例阴性乙肝e抗原(HBeAg),HBV DNA <20,000 IU / ml和ALT正常基线Fibroscan的接受肝脏硬度测量(LSM)在2006-2008年和2010-2012年再次。 LSM增加了30%以上,且绝对LSM提示晚期肝纤维化在第二次评估被定义为纤维化进展。
结果:在基线时,平均年龄为49±11岁,53%为男性,ALT为29±11 IU / L,HBV-DNA为2.7±0.9 log IU /ml,B型肝炎表面抗原(HBsAg)的为2.5±1.4 log IU /ml,,和LSM为6.4±3.2kpa。 56(13.4%)患者在基线中晚期肝纤维化。的时间间隔为44±7个月,没有先进的基线纤维化纤维化进展,49(13.6%)需要抗病毒治疗的361例(2.8%)10。其中244名患者与基线HBV DNA <2000 IU /毫升,11.9%的HBV DNA≥20000 IU / ml的随访过程中,8.2%需要抗病毒治疗和2.9%有纤维化的进展。 117例基线HBV DNA 2,000-20,000 IU /毫升的相应数字分别为16.4%,24.8%和2.6%,分别为(<0.001 = 0.76,P <0.001)。此外,HBsAg的HBV DNA的水平没有提高预测的结果。
结论:在2,000-20,000 IU / ml的HBV DNA有类似的低风险纤维化进展,但更容易患上与HBV DNA比治疗指征的患者,HBeAg阴性和ALT正常,<2,000 IU /毫升。
致谢:本研究得到(参考11100372)香港特区政府为控制传染病研究基金。作者: 宁静温泉 时间: 2013-4-16 20:52