[AGA2015](2024)慢性非活动乙型肝炎病毒：更多良性比我们想象

StephenW

2024
Chronic Inactive Hepatitis B Virus: More Benign Than We Think!
Abdalla Hassan, MD1, Winnie Sheu Woc , MD1, Ayman Abdo, MD2, Dana Villiens1. 1. Advocate Illinois
Masonic Medical Center, Chicago, IL; 2. King Khalid University Hospital, King Saud University, Riyadh,
Saudi Arabia.
Introduction: Hepatitis B virus (HBV) is one of the most common viral infections worldwide, the natural
history of which does not always progress in a linear fashion. We aimed to identify the natural history
of chronic inactive hepatitis B virus over the course of 15 years, and to describe the changes in the liver
condition using AST platelet ratio index (APRI) score as a measure of liver fibrosis.
Methods: Th is is a prospective cohort study following 69 patients aged 30-60 years who have had
inactive hepatits B virus for 15 years. APRI score was calculated at the time of diagnosis and 15 years
later. Inactive hepatitis B virus was identified as PCR < 2000 with normal liver enzymes and no clinical
symptoms regardless of their HBe Ag status. APRI score was used as a non-invasive measure of
liver fibrosis.
Results: Of the 69 patients, 37 were females (54%), and 32 were males (46%). Upon diagnosis, 87%
percent of patients were Hepatitis eAg negative, while only 13% were positive. At the end of the 15 year
follow-up, 93% of patients were Hepatitis e Ag negative. At the time of diagnosis, the mean APRI score
was 0.33 ± 0.17 suggestive of minimal fibrosis and the mean bilirubin was 9.6 ± 6.8 μmol/L. However,
15 years later, the mean APRI score remained 0.33 ± 0.36. (P=.12) while the mean bilirubin decreased to
8.5 ± 4.5 μmol/L (P= < .001).
Conclusion: The natural history of hepatitis B is variable and multifactorial; the main component is the
activity level of the virus. There is limited data on the natural history of inactive hepatitis B virus, and our
study is one of the few long-term prospective studies to be done on this category of hepatitis B patients.
Based on these results, we believe that inactive hepatitis B virus is more benign than what is commonly
thought, with minimal risk of liver damage, even long term. Additional large scale prospective studies are
needed to validate these results and to improve our overall understanding of the nature of the inactive
form of this virus.




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StephenW

2024
慢性非活动乙型肝炎病毒：更多良性比我们想象！
阿卜杜拉·哈桑，MD1，小熊SHEU妇委会，MD1，艾曼·阿卜杜，MD2，达纳Villiens1。 1.倡导伊利诺伊
共济会医疗中心，芝加哥，伊利诺伊; 2.哈立德国王大学医院，沙特国王大学，利雅得，
沙特阿拉伯。
介绍：乙型肝炎病毒（HBV）是最常见的病毒感染的一种全世界，自然
其中历史并不总是以线性方式进步。我们的目的是确定的自然史
慢性非活动乙型肝炎病毒在15年的过程中，以及描述的变化的肝脏
条件使用AST血小板比值指数（APRI）得分为肝纤维化的措施。
方法：钍是是一项前瞻性队列研究，下列69例，年龄30-60岁谁曾
不活动的乙型肝炎病毒15年。 APRI得分计算在诊断和15岁的时候
后来。非活动乙肝病毒被认定为PCR <2000与正常肝酶和无临床
症状无论其抗HBe抗原的地位。 APRI得分作为一种非侵入性的度量
肝纤维化。
结果：69例患者中，有37名女性（54％），32人为男性（46％）。经诊断，87％
患者％为肝炎EAG负，而只有13％为阳性。在15年底
随访，93％的患者为戊型肝炎抗原阴性。在诊断时，平均得分APRI
为0.33±0.17暗示最小纤维化和平均胆红素为9.6±6.8微摩尔/升。然而，
15年后，平均APRI比分保持0.33±0.36。 （P = 0.12），而平均胆红素下降到
8.5±4.5微摩尔/升（P = <0.001）。
结论：乙肝的自然病程是可变的，多因素的;的主要成分是
病毒的活性水平。上有不活动的乙型肝炎病毒的自然历史数据有限，而我们的
研究是为数不多的长期的前瞻性研究中的一个要在这一类乙型肝炎患者进行。
基于这些结果，我们认为，不活动的乙肝病毒是比一般为更良性
认为，与肝损害的风险最小，甚至长期的。其他大规模的前瞻性研究
来验证这些结果，并以改进的非活动的性质我们整体理解所需
形式是病毒。

囧大叔

这是什么意思？

zgct

不太理解

HBVCURER

经过长期的临床/随访观察，得出结论：“Chronic Inactive Hepatitis B Virus”没啥大不了的。
流行病学数据表明，乙肝人群中有大约90%是此类慢性非活动性携带，但临床上如何严格准确界定非活动性携带还存在一定的争议。此类携带与功能性治愈其实只有一线之隔，事实上有很大比例的非活动性携带在多年之后会自动转阴（其几率和HBsAg的载量成“反比”），但其临床预后按以前的传统观念认为还是要小心。此项研究得出的结论比之前的传统观念要乐观的多。