AASLD2018[2131]未治疗免疫性肝病的肝病进展 耐受期慢性乙型肝

StephenW

2131
Liver Disease Progression in Untreated Immune
Tolerant Phase Chronic Hepatitis B Patients
Compared to Treated Immune Active Phase
Patients
Jung Hyun Kwon, Internal Medicine, Incheon St. Mary’s
Hospital, the Catholic University of Korea, Sung Won Lee,
Department of Internal Medicine, College of Medicine, the
Catholic University of Korea and Jeong Won Jang, Department
of Internal Medicine, The Catholic University Liver Research
Center, College of Medicine, the Catholic University of Korea
Background: Chronic hepatitis B (CHB) can be controlled
by antiviral therapy, but not all CHB patients are currently
indicated. Especially, antiviral therapy in patients with normal
alanine aminotransferase (ALT) is still controversial. We
assessed the risk factors for liver disease progression in
untreated immune tolerant (IT) phase patients compared to
antiviral-treated immune active (IA) phase patients. Methods:
This study included consecutive CHB patients in 3 large
volume hospitals in Korea who tested positive for HBeAg and
had an HBV DNA level of > 1,000,000 IU/ml, no evidence of
cirrhosis and an ALT level of <80 IU/L as untreated IT group.
IT group was sub-analyzed into three group depending on
ALT levels (I: < 35 IU/L for men and < 25 IU/L for women,
II: < 40 IU/L, III: < 80 IU/L). Control group IA was defined as
the same criteria except for receiving antiviral therapy due to
the elevated aminotransferase > 80 IU/L. Results: A total of
509 patients were included: 235 were in untreated IT (I: 113
II:173, III:235) and 274 were in treated IA group. Follow up
period was 41 month in IT and 51 month in IA group. The
IT group was significantly younger than IA group (36 yearold
vs 43 year-old, P=0.000). Baseline liver function was
significantly more favorable in the IA group. Among IT group,
56 (23.8%) patients eventually started antiviral therapy. Age
> 35 year and baseline high ALT level (II and III group vs.
I group) were significant risk factors for immune activation
(P<0.05). Progression to cirrhosis (4.3% vs 1.8%, P=0.054)
was higher in the untreated IT group than treated IA group.
HCC was developed 1.7% in untreated IT and 0.4% in
treated IA group (P=0.220). By logistic regression analysis
for progression to cirrhosis, age > 40 year-old and high level
of PT INR were significant risk factors in untreated IT group.
However, in treated IA group, there were no significant factor
including age and baseline liver function for predicting liver
cirrhosis. Conclusion: The present study suggested that
older age and higher ALT level even < 80 IU/L in the untreated
IT group were risk factors for future immune activation.
Progression to cirrhosis was higher in untreated IT group
than treated IA group, although it was statistically borderline.
Interestingly, older age and poor liver function were risk
factors for progression to cirrhosis in untreated IT group, but
the effects of these factors on progression to cirrhosis were
offset by antiviral therapy in the treated IA group.

StephenW

2131
未治疗免疫性肝病的肝病进展
耐受期慢性乙型肝炎患者
与治疗的免疫活动期相比
耐心
Jung Hyun Kwon，内科，仁川圣玛丽
医院，韩国天主教大学，Sung Won Lee，
医学院内科，
韩国天主教大学和Jeong Won Jang系
内科学，天主教大学肝脏研究
韩国天主教大学医学院中心
背景：可以控制慢性乙型肝炎（CHB）
通过抗病毒治疗，但目前并非所有CHB患者
表示。特别是，患者的抗病毒治疗正常
丙氨酸氨基转移酶（ALT）仍有争议。我们
评估了肝病进展的危险因素
未治疗的免疫耐受（IT）期患者相比
抗病毒治疗的免疫活性（IA）期患者。方法：
本研究纳入3例大型连续CHB患者
韩国大量医院检测HBeAg和HBeAg阳性
HBV DNA水平> 1,000,000 IU / ml，没有证据表明
肝硬化和未治疗IT组的ALT水平<80 IU / L.
IT小组根据分组分为三组
ALT水平（I：男性<35 IU / L，女性<25 ​​IU / L，
II：<40IU / L，III：<80IU / L）。对照组IA定义为
相同的标准，除了因接受抗病毒治疗
升高的氨基转移酶> 80 IU / L.结果：共计
纳入509名患者：235名患者未接受治疗（I：113
II：173，III：235）和274在治疗的IA组中。跟进
IT期为41个月，IA组为51个月。该
IT组明显比IA组年轻（36岁
vs 43岁，P = 0.000）。基线肝功能是
在IA组中显着更有利。在IT集团中，
56名（23.8％）患者最终开始抗病毒治疗。年龄
> 35岁和基线高ALT水平（II和III组vs.
I组）是免疫激活的重要危险因素
（P <0.05）。进展为肝硬化（4.3％vs 1.8％，P = 0.054）
未治疗的IT组高于治疗的IA组。
HCC在未经治疗的IT中发展为1.7％，在未经治疗的中为0.4％
治疗IA组（P = 0.220）。通过逻辑回归分析
进展为肝硬化，年龄> 40岁，高水平
PT INR是未治疗IT组的重要危险因素。
然而，在治疗的IA组中，没有重要因素
包括年龄和基线肝功能预测肝脏
肝硬化。结论：本研究表明
年龄较大且ALT水平较高，甚至<80 IU / L未经治疗
IT组是未来免疫激活的风险因素。
未经治疗的IT组进展为肝硬化较高
比治疗IA组，虽然它在统计学上是临界的。
有趣的是，年龄较大和肝功能较差的风险
未经治疗的IT组发展为肝硬化的因素，但是
这些因素对进展为肝硬化的影响是
在治疗的IA组中通过抗病毒治疗抵消。