Article in Press
Progression to cirrhosis, hepatocellular carcinoma and liver-related
mortality in chronic hepatitis B patients in Italy
Donatella Ieluzzi, Loredana Covolo, Francesco Donato, Giovanna Fattovich
Corresponding Author Information
email address
Received 11 July 2013; accepted 10 January 2014. published online 18
February 2014.
Abstract
Background
The natural history of chronic hepatitis B is variable. We evaluated some
of the risk factors for cirrhosis, hepatocellular carcinoma and
liver-related mortality in Italian patients with chronic hepatitis B.
Methods A cohort of 105 untreated patients with chronic hepatitis B without
cirrhosis at diagnosis was followed prospectively for a mean period of 23
years. Clinical, histological and ultrasound examinations, biochemical and
virological tests, and causes of death were analyzed. Results Forty-two
(40%) patients became inactive carriers and 63 (60%) showed persistent
alanine aminotransferase elevation: 13 (13%) associated with HBeAg
persistence, 35 (33%) with detectable serum HBV-DNA but HBeAg-negative, 11
(10%) with concurrent virus infection and 4 (4%) with non-alcoholic fatty
liver disease. Cirrhosis incidence was 1.56/100 person-years. Older age and
sustained HBV replication predicted cirrhosis occurrence independently.
Hepatocellular carcinoma incidence was 2.1/100 person-years in patients who
developed cirrhosis and 0.06 in those who did not. Cirrhosis occurrence
was associated with an increased risk of hepatocellular carcinoma (hazard
ratio 20.4, 95% confidence interval 2.54–167.5) and liver-related death
(16.5, 2.0–138.8). Conclusions In Italian patients with chronic hepatitis
B cirrhosis strongly predicts hepatocellular carcinoma occurrence and
disease-related mortality, thus indicating that early antiviral treatment
should be instituted before cirrhosis occurrence. 作者: StephenW 时间: 2014-2-21 09:35