AASLD2019[654]未经治疗的欧洲患者的临床结果 七年后感染慢性

StephenW

654
CLINICAL OUTCOMES IN UNTREATED EUROPEAN PATIENTS
WITH CHRONIC HEPATITIS B VIRUS INFECTION AFTER SEVEN
YEARS: A PROSPECTIVE LONGITUDINAL STUDY (ALBATROS
STUDY)
Christiana Graf1, Viola Knop1, Kai-Henrik Peiffer1, Julia Dietz1,
Thomas Berg2, Heiner Wedemeyer3, Markus Cornberg4,
Jörg Petersen5, Dietrich Hueppe6, Martin Sprinzl7, Stefan
Mauss8, Michael Rausch9, Peter Buggisch5, Markus Bickel10,
Hartwig Klinker11, Stefan Zeuzem1, Johannes Vermehren1
and Christoph Sarrazin12, (1)Department of Internal Medicine
I, University Hospital Frankfurt, Germany, (2)Department of
Gastroenterology and Rheumatology, Section of Hepatology,
University Hospital Leipzig, Germany, (3)Department of
Gastroenterology and Hepatology, Essen University Hospital,
Essen, Germany, (4)Department of Gastroenterology,
Hepatology and Endocrinology, Hannover Medical School,
Hannover,Germany, (5)IFI Institute for Interdisciplinary
Medicine, Asklepios Klinik St. George, University of Hamburg,
(6)Practice for Gastroenterology, Herne, Germany, (7)
Department of Medicine I, University Medical Center Mainz,
Germany, (8)Center for HIV and Hepatogastroenterology,
Düsseldorf, Germany, (9)Center for Infectiology, Berlin,
Germany, (10)Center for Infectiology, Frankfurt, Germany, (11)
Internal Medicine, University Hospital Wuerzburg, Germany,
(12)Medical Clinic 2, St. Josefs Hospital Wiesbaden, Germany
Background: Chronic infection with the hepatitis B virus
(HBV) is associated with chronic hepatitis, liver cirrhosis
and hepatocellular carcinoma The clinical course and
outcome of HBV infection varies among different individuals.
The aim of the present analysis was to assess predictive
factors associated with clinical outcomes during long-term
follow-up in a prospective observational cohort of patients
with low replicative HBV and absence of significant liver
inflammation or fibrosis at the time of study inclusion.
Methods: 1192 consecutive patients with chronic HBeAgnegative
HBV-infection (43% men, mean age 42 ±12 years)
were prospectively followed for up to seven years All study
participants were considered not to be candidates for antiviral
treatment at study inclusion based on international guideline
recommendations Patients were also included if they had
HBV DNA levels >2000 IU/ml and normal ALT or low HBV DNA
≤2000 IU/ml and elevated ALT during follow-up. Virological,
biochemical and non-invasive fibrosis parameters (transient
elastography (TE) and point shearwave elastography (pSWE))
were performed at baseline and during annual follow-up
Treatment decisions were made based on the development
of active carrier state (HBV DNA >2000 IU/ml plus repeated
elevated ALT and/or advanced fibrosis/cirrhosis). Results:
Mean HBV DNA and alanine serum transferase (AST) serum
concentrations at baseline were 3 65 log10IU/mL (SD=4 5) and
28 76 U/mL (SD=14 11), respectively A total of 47 individuals
cleared HBsAg during follow-up (6 6 per 100 person years)
Low HBsAg (p<0.001), low HBV-DNA (p<0.001) and low ALT
values (p=0 027) were predictive of HBsAg seroclearance
Antiviral treatment was started in 46 patients (6 4 per 100
person years). High HBsAg (p=0.006), HBV-DNA >2000 IU/ml
(p=0 005), high ALT (p<0 001) and high TE values (p<0 001)
at baseline were significantly associated with development of
re-activation of HBV infection. Patients with HBsAg ≤1000 IU/
ml, HBV DNA ≤2000 IU/ml and normal ALT at baseline had a
minimal risk of disease progression after seven years (n=305,
26% of patients; NPV >98%). In the seven years of followup,
median TE did not differ significantly from baseline values
(median intra-patient changes at the end of follow-up relative
to baseline, TE: 0.30, p=0.43) and none of the patients
developed HCC Conclusion: Baseline levels of HBsAg and
HBV DNA were strong predictors of both re-activation of HBV
infection and HBsAg seroclearance in this predominantly
Caucasian cohort Follow-up of the cohort for 10 years is
planned to determine long-term prognosis and to evaluate
dynamics of HBV infection leading to disease progression.

StephenW

654
未经治疗的欧洲患者的临床结果
七年后感染慢性乙型肝炎病毒
年份：前瞻性纵向研究（ALBATROS
研究）
Christiana Graf1，Viola Knop1，Kai-Henrik Peiffer1，Julia Dietz1，
Thomas Berg2，Heiner Wedemeyer3，Markus Cornberg4，
JörgPetersen5，Dietrich Hueppe6，Martin Sprinzl7，Stefan
Mauss8，Michael Rausch9，Peter Buggisch5，Markus Bickel10，
Hartwig Klinker11，Stefan Zeuzem1，Johannes Vermehren1
和Christoph Sarrazin12，（1）内科
我，德国法兰克福大学医院，（2）
胃肠病和风湿病学，肝病科，
德国莱比锡大学医院（3）
埃森大学医院消化内科和肝病科，
德国埃森（4）消化内科，
汉诺威医学院，肝内分泌科
汉诺威，德国，（5）IFI跨学科研究所
医学，汉堡大学，Asklepios Klinik St. George，
（6）胃肠病学实践，德国黑尔讷（7）
美因茨大学医学中心第一医学系
德国，（8）艾滋病毒和肝肠胃病学中心，
德国杜塞尔多夫（9）柏林传染病学中心，
德国（10）德国法兰克福传染病学中心（11）
德国维尔茨堡大学医院内科，
（12）德国威斯巴登圣约瑟夫斯医院第二诊所
背景：乙型肝炎病毒的慢性感染
（HBV）与慢性肝炎，肝硬化有关
和肝细胞癌的临床过程和
HBV感染的结果因人而异。
本分析的目的是评估预测性
长期临床结果相关因素
对患者进行前瞻性观察队列的随访
乙型肝炎病毒复制率低且无明显肝脏
纳入研究时出现炎症或纤维化。
方法：连续1192例慢性HBeAg阴性患者
HBV感染（43％的男性，平均年龄42±12岁）
进行了长达七年的前瞻性随访研究
参与者被认为不是抗病毒药物的候选人
根据国际指南对研究纳入进行治疗
建议如果有
HBV DNA水平> 2000 IU / ml和正常ALT或低HBV DNA
随访期间≤2000 IU / ml且ALT升高。病毒学
生化和非侵入性纤维化参数（瞬态
弹性成像（TE）和点剪切波弹性成像（pSWE））
在基线和年度随访期间进行
根据发展情况制定治疗决策
活性携带者状态（HBV DNA> 2000 IU / ml，再重复一次）
ALT升高和/或晚期纤维化/肝硬化）。结果：
平均HBV DNA和丙氨酸血清转移酶（AST）血清
基线浓度为3 65 log10IU / mL（SD = 4 5）
28 76 U / mL（SD = 14 11），总共47个人
随访期间清除HBsAg（每100人年6 6）
低HBsAg（p <0.001），低HBV-DNA（p <0.001）和低ALT
值（p = 0 027）可预测HBsAg血清清除率
开始对46例患者进行抗病毒治疗（每100例6 4例）
人年）。高HBsAg（p = 0.006），HBV-DNA> 2000 IU / ml
（p = 0 005），高ALT（p <0 001）和高TE值（p <0 001）
基线时与
重新激活HBV感染。 HBsAg≤1000IU /的患者
ml，HBV DNA≤2000IU / ml和基线时的正常ALT
七年后疾病进展的风险最小（n = 305，
26％的患者； NPV> 98％）。在接下来的七年中
TE的中位数与基线值无显着差异
（随访结束时患者的中位住院变化）
到基线，TE：0.30，p = 0.43），没有患者
发达的HCC结论：基线水平的HBsAg和
HBV DNA是HBV重新激活的有力预测因子
主要是感染和HBsAg血清清除
高加索队列10年的随访
计划确定长期预后并进行评估
乙肝病毒感染的动态变化导致疾病进展。