AASLD2018[2078]慢性病进展的危险因素 急性乙型肝炎患者的肝炎

StephenW

s 2078
Risk Factors for Progression to Chronic
Hepatitis in Patients with Acute Hepatitis B:
Results from the Acute Hepatitis B Global Study
Sebastian Marciano1, Diego Flichman2,3, Julieta Trinks3,4,
Manuel Mendizabal5, Beatriz Livellara6, Diego Arrigo6, Pablo
Calzetta7, Claudia Vujacich8, Diego Giunta9 and Adrián
Gadano1, (1)Hepatología and Departamento De Investigación,
Hospital Italiano De Buenos Aires, (2)Cátedra De Virología,
Facultad De Farmacia y Bioquímica, Universidad De Buenos
Aires, Buenos Aires., (3)Consejo Nacional De Investigaciones
Científicas y Técnicas (CONICET), (4)Instituto De Ciencias
Básicas y Medicina Experimental (ICBME), Hospital Italiano
De Buenos Aires, (5)Unidad De Hígado y Trasplante Hepático,
Hospital Universitario Austral, (6)Laboratorio Central, Hospital
Italiano De Buenos Aires, (7)División Gastroenterología,
Hospital Juan a Fernández, (8)Fundación Centro De Estudios
Infectológicos (FUNCEI), (9)Departamento De Investigación
and Área De Investigación De Medicina Interna, Hospital
Italiano De Buenos Aires
Background: There are no recognized risk factors for
progression to chronic hepatitis in adults with acute hepatitis
B virus (HBV) infection. We aimed to identify risk factors of
progression to chronic hepatitis in adults with acute hepatitis
B. Methods: From August/2015 to September/2017 patients
aged >17 years with acute hepatitis B were prospectively
included. Patient who received immunosuppression over the
24 week-period prior to enrolment or who were unwilling to
consent were excluded. Acute hepatitis B was considered in
symptomatic patients with positive anti-HBc IgM and ALT >
250 IU/L. Patients were followed for 6 months and divided into
two groups according to the evolution of the acute infection:
patients who resolved the infection (HBsAg clearance during
follow up) and patients who evolved to chronic hepatitis
(HBsAg persistence during follow up). We evaluated the effect
of different factors on evolution to chronic hepatitis, including
ALT<1700 IU/L at diagnosis. We chose this cutoff based on
ROC curve analysis [negative predictive value of evolving
to chronic hepatitis 97.7% (95%CI 93.3%-99.5%)]. Results:
Two hundred patients were included. Median age was 44 (35-
56) years and 163 (81%) were male. Sexual transmission was
declared in 169 (84%) patients. HBV genotype was available
in 145 patients: F: 111 (77%), A: 29 (20%) and D: 5 (3%).
At diagnosis 171 (89%) were HBeAg-positive. A total of 23
patients (11.5%, 95% CI: 7.7%- 17.0%) evolved to chronic
hepatitis. Bivariate analysis is shown in table 1. After adjusting
for age, basal bilirubin and prothrombin time, for every increase
in 100 IU/L in ALT at the moment of the diagnosis, the odds of
evolving to chronic hepatitis was 0.85 (95%CI 0.78 - 0.92, p <
0.001). Adjusting for the same variables, the odds of evolving
to chronic hepatitis in patients with ALT<1700 IU/L at diagnosis
was 8.32 (95%CI 2.20 - 31.40, p 0.002) Conclusion: Patients
with acute HBV infection with lower ALT levels at diagnosis
are at higher risk of evolving to chronic hepatitis. Closer follow
up of these patients is recommended.

StephenW

2078
慢性病进展的危险因素
急性乙型肝炎患者的肝炎：
急性乙型肝炎全球研究的结果
Sebastian Marciano1，Diego Flichman2,3，Julieta Trinks3,4，
Manuel Mendizabal5，Beatriz Livellara6，Diego Arrigo6，Pablo
Calzetta7，Claudia Vujacich8，Diego Giunta9和Adrián
Gadano1，（1）Hepatología和DepartamentoDeInvestigación，
Italiano De Buenos Aires医院，（2）CátedraDeVirología，
Facultad De Farmacia和Bioquímica，Universidad De Buenos
Aires，Buenos Aires。，（3）Consejo Nacional De Investigaciones
CientíficasyTécnicas（CONICET），（4）Instituto De Ciencias
BásicasyMedicina Experimental（ICBME），意大利医院
De Buenos Aires，（5）UnidadDeHígadoyTrasplanteHepático，
Hospital Universitario Austral，（6）Laboratorio Central，Hospital
Italiano De Buenos Aires，（7）DivisiónGastroenterología，
医院JuanaFernández，（8）FundaciónCentroDe Estudios
Infectológicos（FUNCEI），（9）DepartamentoDeInvestigación
和ÁreaDeInvestigaciónDeMedicina Interna，Hospital
Italiano De Buenos Aires
背景：没有公认的风险因素
急性肝炎患者进展为慢性肝炎
B病毒（HBV）感染。我们的目标是确定风险因素
急性肝炎患者进展为慢性肝炎
B.方法：从2015年8月至2017年9月的患者
年龄> 17岁的急性乙型肝炎患者为前瞻性
包括在内。接受免疫抑制的患者
入学前24周或不愿意
同意被排除在外。急性乙型肝炎被认为是
有抗HBc IgM和ALT阳性的症状性患者>
250 IU / L.患者随访6个月并分为
两组根据急性感染的演变情况：
解决感染的患者（HBsAg清除期间）
跟进）和进化为慢性肝炎的患者
（随访期间HBsAg持续存在）。我们评估了效果
不同因素对慢性肝炎的演变，包括
诊断时ALT <1700 IU / L.我们选择了基于此的截止值
ROC曲线分析[演变的负面预测值
慢性肝炎97.7％（95％CI 93.3％-99.5％）]。结果：
纳入了200名患者。中位数年龄为44岁（35-
56）年和163（81％）是男性。性传播是
在169名（84％）患者中宣布。 HBV基因型可用
在145名患者中：F：111（77％），A：29（20％）和D：5（3％）。
诊断时，171例（89％）为HBeAg阳性。共23个
患者（11.5％，95％CI：7.7％ - 17.0％）进化为慢性病
肝炎。双变量分析如表1所示。调整后
对于年龄，基础胆红素和凝血酶原时间，每增加一次
在诊断时ALT中100 IU / L的几率
进展为慢性肝炎为0.85（95％CI 0.78 - 0.92，p <
0.001）。调整相同的变量，进化的几率
诊断时ALT <1700 IU / L的患者为慢性肝炎
是8.32（95％CI 2.20 - 31.40，p = 0.002）结论：患者
急性HBV感染，诊断时ALT水平较低
患慢性肝炎的风险较高。仔细跟随
建议这些患者。