AASLD2020[741]病毒载量和肝硬度与 严重的纤维化和疾病进展 HBEA

StephenW

741
VIRAL LOAD AND LIVER STIFFNESS ARE RELATED TO
SIGNIFICANT FIBROSIS AND DISEASE PROGRESSION IN
HBEAG NEGATIVE PATIENTS. A REAL-LIFE COHORT STUDY.
Luisa Roade1,2, Mar Riveiro Barciela3, Elena Vargas-Accarino4,
Adriana Palom1,4, Ana Barreira-Diaz1, Cristina Marcos Fosch1,
Maria Asuncion Buti Ferret3 and Rafael Esteban-Mur5, (1)
Liver Unit, Internal Medicine Department. Hospital Universitari
Vall d’Hebron, Barcelona, Spain, (2)Centro De Investigación
Biomédica En Red, Enfermedades Hepáticas y Digestvas
(CIBERehd), Instituto De Salud Carlos III, Madrid, Spain, (3)
Liver Unit, Internal Medicine Department. Hospital Universitari
Vall d’Hebron, Barcelona, Spain, University Hospital Vall
D’hebron, (4)Vall D’hebron Institut De Recerca, (5)Liver Unit,
Hospital Vall D’hebron
Background: management of chronic hepatitis B virus
infection is challenging due to its dynamic nature and the
prognosis of different stages of HBV infection Despite noninvasive
markers, liver biopsy is still needed in majority of cases
to characterize these patients Aim: to assess the usefulness
of non-invasive markers in HBeAg-negative individuals for
the prediction of significant fibrosis and treatment eligibility
criteria Methods: observational study of HBeAg negative
subjects chronically infected by HBV Clinical, serological and
virological data were collected annually. Liver fibrosis was
estimated through liver stiffness measurement (LSM) and
non-invasive biomarkers (APRI and FIB-4) Subjects were
classified at baseline in HBV chronic carriers, HBeAg negative
chronic hepatitis B (CHB) and grey zone (normal ALT+HBVDNA
>2000 IU/mL) and reclassified at the end of follow-up. A
liver biopsy was performed in patients with persistent HBVDNA>
2, 000 IU/mL +normal ALT). Results: 372 subjects
were included; baseline characteristics are summarized
in table1. At baseline 244 (66%) were classified as chronic
carriers, 22(6%) as HBeAg negative CHB and 106(29%)
as grey zone Liver biopsy was performed in 92 individuals
(25%) with significant fibrosis (F≥2 Ishak) in 21(23%). Those
undergoing liver biopsy presented baseline higher ALT (26 vs
50IU/ml, p<0 0001), qHBsAg (3 vs 3 6 log IU/ml, p<0 001),
HBV DNA(2 4 vs 3 8log IU/ml, p<0 001) and LSM (5 4kPa vs
6 3kPa, p=0 012) Baseline factors independently associated
with significant fibrosis were higher HBV-DNA (reference
<2000IU/ml vs 2000-20000IU/ml vs 20000IU/ml, OR=6 6)
and LSM (LSM>6.5kPa, OR=2.9). Baseline LSM showed
an AUROC of 0.8 for identification of significant fibrosis. Out
of 335 individuals with ≥1follow-up, 285(85%) were finally
considered chronic carriers and 43(13%) CHB Among 106
patients classified as grey zone, HBV-DNA (OR=3.1), and
LSM (OR=6.1) were associated with later classification as
CHB. 7 subjects remained unclassifiable due to high viral
loads with mild/absent fibrosis in liver sample. 47 subjects
initiated HBV therapy during follow-up, HBsAg was lost in
24(6 5%) and one decompensation and one liver-related
death were registered Conclusion: baseline viral load and
liver stiffness are the only predictors for significant fibrosis
and evolution to CHB in a real-life cohort of HBeAg negative
subjects An invasive approach is needed in up to 25% of
subjects for proper classification.

StephenW

741
病毒载量和肝硬度与
严重的纤维化和疾病进展
HBEAG阴性患者。真实队列研究。
Luisa Roade1,2，Mar Riveiro Barciela3，Elena Vargas-Accarino4，
Adriana Palom1,4，Ana Barreira-Diaz1，Cristina Marcos Fosch1，
玛丽亚·亚松森（Maria Asuncion）Buti Ferret3和Rafael Esteban-Mur5（1）
内科肝病科。大学医院
西班牙巴塞罗那，瓦勒·德·希布伦（2）
BiomédicaEn Red，Hepáticasy Digestvas
（CIBERehd），萨卢德·卡洛斯三世研究所，西班牙马德里，（3）
内科肝病科。大学医院
瓦勒·希伯伦，西班牙巴塞罗那，瓦勒大学医院
D'hebron，（4）Vall D'hebron Institut De Recerca，（5）肝脏病房，
瓦尔·德希伯伦医院
背景：慢性乙型肝炎病毒的管理
由于其动态性质和
无创性HBV感染不同阶段的预后
标志物，大多数情况下仍需要肝活检
表征这些患者的目的：评估有用性
HBeAg阴性患者中非侵入性标志物的检测
预测明显的纤维化和治疗资格
评估方法：HBeAg阴性的观察性研究
慢性感染HBV的受试者临床，血清学和
每年收集病毒学数据。肝纤维化原为
通过肝硬度测量（LSM）估算
非侵入性生物标志物（APRI和FIB-4）
HBV慢性携带者基线分类，HBeAg阴性
慢性乙型肝炎（CHB）和灰色区（正常ALT + HBVDNA
> 2000 IU / mL），并在随访结束时重新分类。一种
持续性HBVDNA患者进行肝活检>
2，000 IU / mL +正常ALT）。结果：372个主题
被包括在内;基线特征总结
在表1中。在基线244（66％）被分类为慢性
携带者，HBeAg阴性CHB为22（6％），106为（29％）
因为有灰色区域，所以有92位患者进行了肝活检
21％（23％）的患者中（25％）有明显的纤维化（F≥2Ishak）。那些
接受肝活检的患者基线ALT较高（26 vs
50IU / ml，p <00001），qHBsAg（3 vs 3 6 log IU / ml，p <00001），
HBV DNA（2 4 vs 3 8log IU / ml，p <0 001）和LSM（5 4kPa vs
6 3kPa，p = 0 012）独立关联的基线因子
肝纤维化明显者HBV-DNA较高（参考
<2000IU / ml对2000-20000IU / ml对20000IU / ml，或= 6 6）
和LSM（LSM> 6.5kPa，OR = 2.9）。基线LSM显示
AUROC为0.8，用于识别明显的纤维化。出
随访≥1的335人中，有285人（占85％）
被认为是慢性携带者，在106个国家中有43（13％）个CHB
分为灰色区，HBV-DNA（OR = 3.1）和
LSM（OR = 6.1）与以后的分类相关，因为
CHB。 7名受试者因高病毒而无法分类
肝样本中有轻度/无纤维化负荷。 47个科目
在随访期间开始HBV治疗，HBsAg丢失
24（6 5％）和一种代偿失调与一种肝相关
死亡登记结论：基线病毒载量和
肝脏僵硬是严重纤维化的唯一预测因子
现实人群HBeAg阴性人群中向CHB的转化和进化
科目高达25％的人需要采取侵入性方法
适当分类的主题。