EASL 2013不活跃的乙肝病毒携带者的纤维化进展

StephenW

Abstract 434
     
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

StephenW

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。

宁静温泉

大致归纳：研究非活跃性HBV携带者潜在的纤维化进展风险。
非活跃性的定义：HBeAg(e抗原)阴性，HBVDNA<20,000 IU/ml，ALT正常。
纤维化进展的定义：LSM（一种对肝脏硬度的评估方法）值相对基线水平增加30%以上，或者达到中晚期肝纤维化的水平。

一共417例年龄在49±11之间的患者，接受了为期44±7个月的跟踪观察。观察的数据如下：

   1）大约2.8%在基线时无明显纤维化的患者，发展了纤维化。
     - 在基线HBVDNA<2,000IU/ml的患者当中，这个数字是2.9%
         - 在基线HBVDNA介于2,000和20,000IU/ml之间的患者当中，这个数字是2.6%

   2）大约13.6%的人，在跟踪的过程中可能由于病情的发展需要接受抗病毒治疗。
     - 在基线HBVDNA<2,000IU/ml的患者当中，这个数字是8.2%
         - 在基线HBVDNA介于2,000和20,000IU/ml之间的患者当中，这个数字是24.8%

   3）部分患者HBVDNA上升至>20,000IU/ML的水平。
     - 在基线HBVDNA<2,000IU/ml的患者当中，这个数字是11.9%
         - 在基线HBVDNA介于2,000和20,000IU/ml之间的患者当中，这个数字是16.4%


结论：非活跃性的HBV携带者发展肝纤维化的风险较低，并且与HBVDNA的水平无关（只要HBVDNA小于20,000IU/ML）。但是那些基线HBVDNA较高的患者（HBVDNA介于2,000和20,000IU/ml之间），更有可能在这过程中观察到疾病进展，从而需要治疗。


宁静温泉注：文中并没有说明什么样的疾病进展会需要治疗干预，猜测可能是ALT上升。

9病成医

谢谢宁静温泉!当然也要谢谢史蒂分!

咬牙硬挺

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