AASLD 2011:Factors associated with advanced hepatic fibrosis in young patients w

StephenW

Factors associated with advanced hepatic fibrosis inyoung patients with chronic hepatitis B infection
J. J. Sam1; O. Adeyi2; S. K. Fung1
1. Medicine, University of Toronto, Toronto, ON, Canada.
2. Pathology, University of Toronto, Toronto, ON, Canada.

Background: The risk of cirrhosis in chronic hepatitis Bvirus (HBV) infection is approximately 20% and generally occurs in the fifth or sixth decade of life. However, little is known about risk factors for HBV cirrhosis in young patients under the age of 40 years.
Aim: We aimed to determine the risk factors and clinicopathologic characteristics of advanced HBV fibrosis in young (<40 years) vs. older(>40 years) patients.
Methods: A retrospective analysis was performed on adult patients who underwent percutaneous liver biopsy and were found to have advanced fibrosis (F3-4METAVIR). Patients with chronic hepatitis B who attended liver clinics at Toronto General Hospital(Toronto, Canada) between 7/08-12/10 were included. Demographic data, baseline characteristics, and laboratory values were compared between patients <40 years at the time of liver biopsy (Group1) and those >40 years (Group 2).
Results: A total of 262 patients underwent liver biopsy; 33 (13%) patients had stage 3 or 4 fibrosis. Of these, 14 (42%) patients belonged to Group 1, while the remaining 19 (58%) patients were in Group 2. Mean age ± SD in Group 1 and 2was 32.1±5.3 and 49.7±8.7 years, respectively (p< 0.0001). Male gender was predominant in both groups (79% and 63% respectively; p=0.45), and almost allpatients in both groups were Southeast Asian. Patients in group 1 (57%) were more likely to be HBeAg-positive compared to those in group 2 (42%). Genotype C predominated in Group 1 (62%), while genotypes B and C were 47% and 53% respectively in Group 2. All cirrhotic patients were Child-Pugh class A. Mean HBV DNA ± SD in Group 1 was 4.8 ± 1.7 log IU/ml vs. 6.0 ± 1.6 log IU/ml in Group 2(p=0.047). Between the groups, a family history of hepatitis B, cirrhosis and hepatocellular carcinoma was present in 43% vs. 58% (p= 0.49), 7% vs. 32% (p=0.20) and 0% vs. 5% (p=1.0), respectively. There was a higher degree of necroinflammatory activity [A2-3] in liver biopsies in Group 2 compared to Group 1 (68% vs. 23%; p=0.01). Hepatosteatosis >10% was equally prevalent in young and older patients (15% vs. 10%; p=1.0).
Conclusion: Our data indicate that advanced fibrosis among young patients who underwent liver biopsy is common (42% HBV patients with cirrhosis). Young cirrhotic patients tended to have lower serum HBV DNA levels but more necroinflammation on biopsy. Using biopsy as a gold standard, abdominal ultrasound would have missed the diagnosis of cirrhosis in 64% HBV patients<40 years. Further studies are required to elucidate risk factors for development of HBV cirrhosis at a young age.

StephenW

与先进的年轻患者与慢性乙肝病毒感染的肝纤维化的相关因素
J. J.萨姆1; O. Adeyi 2圣公会丰1
1。医药，多伦多大学，多伦多，ON，加拿大。
2。病理学，多伦多大学，多伦多，ON，加拿大。
  
背景：肝硬化慢性乙型肝炎病毒（HBV）感染的风险约20％，一般发生在生命的第五或第六十年。然而，鲜为人知的是40岁的年轻患者为乙肝肝硬化的风险因素下。
目的：我们的目的是确定的风险因素和先进的乙肝纤维化的年轻（<40岁）比年龄较大（> 40岁）患者的临床病理特征。
方法：成年患者接受了经皮肝穿刺活检，并进行回顾性分析，发现有晚期肝纤维化（F3 - 4 METAVIR）。人出席了在多伦多总医院（加拿大多伦多）之间7/08-12/10肝诊所的慢性乙型肝炎患者都包括在内。人口统计数据，基线特征和实验室值<40岁的患者肝活检（第1组）和那些时间> 40年（第2组）之间进行了比较。
结果：共有262例患者进行了肝穿刺活检33例（13％）第3阶段或4纤维化。其中，14例（42％），属于第1组，而其余19例（58％）在第2组。平均年龄± 1和2组SD为32.1 ± 5.3和49.7 ± 8.7年，分别为（P <0.0001）。男性的性别两组（分别为79％和63％; P = 0.45）占主导地位，几乎所有的两组患者东南亚。在第1组（57％）的患者HBeAg阳性，第2组（42％）相比，更容易。 C基因型在第1组（62％）为主，而B和C基因型分别在第2组分别为47％和53％。肝硬化患者Child - Pugh分级A级意味着在第1组HBV DNA的± SD 4.8 ± 1.7日志IU /毫升与6.0 ± 1.6日志IU /毫升在第2组（P = 0.047）。的群体，家族病史的B型肝炎，肝硬化和肝癌之间目前的43％与58％（P = 0.49），7％和32％（P = 0.20）和0％与5％（P = 1.0），分别。有一个更高程度的坏死性炎症活动[A2 - 3]在第2组的肝活检相比，第1组（68％比23％，P = 0.01）。 Hepatosteatosis> 10％是在青年和老年患者（15％和10％; P = 1.0）同样普遍存在。
结论：我们的数据表明，接受肝活检的年轻患者之间的晚期肝纤维化是常见（42％乙肝肝硬化患者）。年轻的肝硬化患者往往有降低血清HBV DNA水平，但更多的活检坏死性炎症。使用活检作为金标准，已经错过了腹部超声在64％​​的乙肝患者肝硬化的诊断<40岁。需要进一步研究阐明乙肝肝硬化发展的风险因素，在年轻的时候。