灰区慢性乙型肝炎病毒感染患者的分布及临床特征

StephenW

Distribution and clinical characteristics of patients with chronic hepatitis B virus infection in the gray zone
Kefang Yao  1 , Jiacheng Liu  2 , Jian Wang  3 , Xiaomin Yan  3 , Juan Xia  3 , Yue Yang  3 , Weihua Wu  3 , Yong Liu  4 , Yuxin Chen  4 , Zhaoping Zhang  3 , Jie Li  5 , Rui Huang  3 , Chao Wu  1   2   3
Affiliations
Affiliations

    1
    Department of Infectious Diseases, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing Jiangsu, China.
    2
    Department of Infectious Diseases, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu, China.
    3
    Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, China.
    4
    Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, China.
    5
    Department of Infectious Disease, Shandong Provincial Hospital affiliated to Shandong University, Ji'nan Shandong, China.

    PMID: 33797145 DOI: 10.1111/jvh.13511

Abstract

A substantial proportion of patients with chronic hepatitis B (CHB) who do not fit into any of the usual immune states are considered to be in the "gray zones ". We aimed to investigate the distribution and characteristics of this gray zone in a large cohort of CHB patients. Four thousand seven hundred and fifty-nine consecutive treatment-naïve CHB patients were enrolled. The immune states were defined based on AASLD 2018 Hepatitis B Guidance. Gray zone CHB patients were classified into 4 groups: HBeAg positive, normal ALT levels, and serum HBV DNA ≤ 106 IU/mL (GZ-A); HBeAg positive, elevated ALT levels and serum HBV DNA ≤ 2×104 IU/mL (GZ-B); HBeAg negative, normal ALT levels and serum HBV DNA ≥ 2×103 IU/mL (GZ-C); HBeAg negative, elevated ALT levels and serum HBV DNA ≤ 2×103 IU/mL (GZ-D). The distributions of different immune states were: 233 (4.90%) patients in immune-tolerant phase, 941 (19.77%) patients in HBeAg-positive immune active phase, 1,717 (36.08%) patients in inactive phase and 546 (11.47%) patients in HBeAg-negative immune active phase. Of note, 1,322 (27.78%) patients did not fit into any of above phases and were defined as the gray zone. A high proportion of patients in GZ-B had advanced fibrosis (33.3%) or cirrhosis (25.8%). Older age, HBeAg positive status and higher ALT levels were independently risk factors of advanced disease in gray zone CHB patients. Therefore, our results revealed that more than a quarter of CHB patients were classified into the gray zone and a high proportion of patients in GZ-B had advanced fibrosis or even cirrhosis.

Keywords: Chronic hepatitis B; gray zone; immune states; indeterminant.

This article is protected by copyright. All rights reserved.

StephenW

灰区慢性乙型肝炎病毒感染患者的分布及临床特征
姚克芳1，刘家成2，王建3，闫小敏3，夏娟3，岳阳3，吴卫华3，刘勇4，陈雨欣4，张兆平3，李杰5，黄瑞3，朝巢3 1 2 3
隶属关系
隶属关系

    1个
    南京医科大学临床学院南京鼓楼医院感染科，江苏南京
    2个
    南京中医药大学中西医结合学院南京鼓楼医院传染病科，江苏南京。
    3
    南京大学医学院附属医院南京鼓楼医院感染科，江苏南京
    4
    南京大学医学院附属医院南京鼓楼医院检验科，江苏南京。
    5
    山东大学附属山东省立医院传染病科，山东济南

    PMID：33797145 DOI：10.1111 / jvh.13511

抽象的

患有慢性乙型肝炎（CHB）的患者中有很大一部分不符合任何通常的免疫状态，被认为处于“灰色区域”。我们的目的是调查一大批CHB患者中该灰色区域的分布和特征。招募了459例连续未接受过治疗的CHB患者。免疫状态是根据AASLD 2018乙型肝炎指南定义的。灰区CHB患者分为4组：HBeAg阳性，ALT正常和血清HBV DNA≤106 IU / mL（GZ-A）； HBeAg阳性，ALT水平升高，血清HBV DNA≤2×104 IU / mL（GZ-B）； HBeAg阴性，ALT正常，血清HBV DNA≥2×103 IU / mL（GZ-C）； HBeAg阴性，ALT水平升高，血清HBV DNA≤2×103 IU / mL（GZ-D）。不同免疫状态的分布是：免疫耐受期为233名（4.90％），HBeAg阳性免疫活性期为941名（19.77％），非活性期为1,717名（36.08％）和546（11.47％）在HBeAg阴性免疫活性期。值得注意的是，有1,322（27.78％）位患者不适合上述任何阶段，被定义为灰色区域。 GZ-B患者中有很大一部分患有晚期纤维化（33.3％）或肝硬化（25.8％）。年龄较大，HBeAg阳性状态和ALT水平较高是灰色区CHB患者晚期疾病的独立危险因素。因此，我们的结果显示，超过四分之一的CHB患者被分类为灰色区域，而GZ-B中有很大比例的患者患有晚期纤维化甚至肝硬化。

关键字：慢性乙型肝炎；灰色地带免疫状态不确定的。

本文受版权保护。版权所有。