EASL2019 THU-219 白种人乙型肝炎患者的长期预后 抗原阴性慢性

StephenW

THU-219
Long-term outcome in Caucasian patients with hepatitis B e
antigen-negative chronic infection: An observational cohort
study
Özgür Koc1,2,3, Geert Robaeys1,2,4, Rob Bielen1,2, Dana Busschots1,2,
Ger Koek3,5, Frederik Nevens4. 1Ziekenhuis Oost-Limburg, Genk,
Belgium; 2Hasselt University, Hasselt, Belgium; 3Maastricht University
Medical Centre, Maastricht, Netherlands; 4University Hospitals
KULeuven, Leuven, Belgium; 5University Hospital of the RWTH, Aachen,
Germany
Email: [email protected]
Background and aims: The long-term outcome and risk of hepatitis
B virus (HBV) reactivation in the Caucasian population with hepatitis
B e antigen (HBeAg)-negative chronic infection have rarely been
studied before. In this study, we explored this issue by a long-term
follow-up of patients with HBeAg-negative chronic infection.
Method: Out of 1, 081 patients with chronic HBV infection,
we retrospectively identified 236 Caucasian patients with HBeAgnegative
chronic infection who presented at the Outpatient
Hepatology Department of University Hospitals KULeuven between
1 January 1968 and 31 July 2018. HBeAg-negative chronic infection
was defined as low or undetectable HBV DNA (≤20, 000 IU/ml) and
persistently normal alanine-aminotransferase levels (PNALT).
Patients previously treated with HBV antiviral agents or corticosteroids
were to be excluded as well as patients with cirrhosis at
presentation and patients with co-existing chronic liver disease.
Figure 1: Cumulative probability of reactivation of hepatitis B in Caucasian
patients with hepatitis B e antigen-negative chronic infection.
Results: During a median follow-up of 10 (interquartile range: 14.2)
years, 208 (88%) of the 236 patients showed sustained remission,
whereas the remaining 28 (12%) experienced reactivation of hepatitis
B. The cumulative probabilities of reactivation of hepatitis B were 2%, 8% and 27% at 5, 10 and 20 years follow-up, respectively (Fig. 1). In a
multivariate analysis using Cox proportional hazards regression
models, reactivation of hepatitis B was independently associated
with advanced age at presentation (>40 years) (hazard ratio (HR) =
2.92; 95% confidence interval (CI) = 1.23-6.92; p = .015) and any HBV
DNA level >2, 000 IU/ml (HR = 3.68; 95% CI = 1.53-8.82; p = .004).
Significant fibrosis (liver stiffness >9 kPa) and cirrhosis developed in
respectively 9/133 (7%) and 3/236 (1%) patients. Cox proportional
hazard regression models showed that advanced age at presentation
was the only factor significantly associated with a higher risk of
significant fibrosis (HR = 4.90; 95% CI = 1.71-14.1; p = .003).
Conclusion: Antiviral treatment is not indicated in Caucasian
patients with HBeAg-negative chronic infection since the prognosis
of liver disease is favourable. However, the results from this study
reinforce the need for clinical surveillance for the risk of HBV
reactivation in patients older than 40 years and those with any HBV
DNA level >2, 000 IU.

StephenW

THU-219
白种人乙型肝炎患者的长期预后
抗原阴性慢性感染：观察性队列
研究
ÖzgürKoc1,2,3，Geert Robaeys1,2,4，Rob Bielen1,2，Dana Busschots1,2，
Ger Koek3,5，Frederik Nevens4。 1 Ziekenhuis Oost-Limburg，Genk，
比利时; 2哈塞尔特大学，比利时哈瑟尔特; 3Maastricht大学
荷兰马斯特里赫特医疗中心; 4所大学医院
KULeuven，比利时鲁汶; 5亚琛工业大学附属医院
德国
电子邮件：[email protected]
背景和目的：肝炎的长期结果和风险
B型病毒（HBV）在患有肝炎的高加索人群中重新激活
B e抗原（HBeAg）阴性慢性感染很少发生
之前研究过。在这项研究中，我们长期探讨了这个问题
对HBeAg阴性慢性感染患者进行随访。
方法：1 081例慢性HBV感染患者，
我们回顾性地确定了236例白种人HBeAg阴性患者
在门诊就诊的慢性感染者
大学医院肝病科KULeuven之间
1968年1月1日和2018年7月31日.HBeAg阴性慢性感染
被定义为低或不可检测的HBV DNA（≤20,000IU/ ml）和
持续正常的丙氨酸 - 氨基转移酶水平（PNALT）。
患者以前接受过HBV抗病毒药物或皮质类固醇激素治疗
被排除在外以及肝硬化患者
介绍和患有共存的慢性肝病的患者。
图1：高加索人乙型肝炎再激活的累积概率
乙型肝炎患者e抗原阴性慢性感染。
结果：中位随访期间10（四分位数间距：14.2）
年，236名患者中有208名（88％）表现出持续缓解，
而剩下的28例（12％）经历了肝炎的再激活
B.随访5年，10年和20年时，乙型肝炎再激活的累积概率分别为2％，8％和27％（图1）。在一个
使用Cox比例风险回归的多变量分析
模型，乙型肝炎的再激活是独立相关的
年龄较大（> 40岁）（风险比（HR）=
2.92; 95％置信区间（CI）= 1.23-6.92; p = .015）和任何HBV
DNA水平> 2,000IU / ml（HR = 3.68; 95％CI = 1.53-8.82; p = .004）。
显着纤维化（肝硬度> 9 kPa）和肝硬化
分别为9/133（7％）和3/236（1％）患者。考克斯比例
危害回归模型显示高龄年龄呈现
是与风险较高相关的唯一因素
显着纤维化（HR = 4.90; 95％CI = 1.71-14.1; p = .003）。
结论：高加索人没有抗病毒治疗
HBeAg阴性慢性感染患者自预后
肝病是有利的。但是，这项研究的结果
强化了对HBV风险的临床监测需求
40岁以上患者和任何HBV患者的再激活
DNA水平> 2,000 IU。