ALT 值正常且病毒血症高的高加索乙型肝炎患者肝脏相关事件

StephenW

ALT 值正常且病毒血症高的高加索乙型肝炎患者肝脏相关事件的长期研究
Ö M Koc 1 2，J Verbeek 3，G H Koek 4 5，R Bielen 1 6，D Busschots 1 6，M Gamil 3，G Robaeys 1 6 3，F Nevens 3
隶属关系
隶属关系

    1
    比利时迪彭贝克哈瑟尔特大学健康与生命科学学院。
    2
    荷兰马斯特里赫特马斯特里赫特大学医学中心+ NUTRIM 学院医学微生物学系。
    3
    比利时鲁汶 KU Leuven 大学医院胃肠病学和肝病学系。
    4
    荷兰马斯特里赫特马斯特里赫特大学医学中心消化内科和肝病科内科。
    5
    德国亚琛大学医院外科。
    6
    消化内科和肝病科，Ziekenhuis Oost-Limburg，Genk，比利时。

    PMID：35304994 DOI：10.51821/85.1.9160

抽象的

背景和研究目的：对于丙氨酸氨基转移酶 (ALT) 水平正常但 HBV DNA 水平 >2,000 IU/mL 的乙型肝炎 e 抗原 (HBeAg) 阴性患者是否应该开始抗病毒治疗一直存在争议。由于亚洲和高加索患者对抗病毒治疗的需求可能不同，我们研究了居住在西欧的高加索患者的长期疾病结果。

患者和方法：116 名诊断时 HBV DNA 水平高（>2,000 IU/mL）的患者被纳入高病毒血症组，而 HBV DNA <2,000 IU/mL 的患者作为对照（n = 327）。所有患者均为高加索人，HBeAg 阴性，ALT 水平正常，诊断时无明显肝病。

结果：高病毒血症组的中位随访时间为 7 + 9.8 年，对照组为 10 + 12.5 年。 10 年内肝脏相关事件的累积概率为 4.8%，而对照组为 0.0% (p=.008)。在多变量分析中，高病毒血症组与肝脏相关事件的发生相关（风险比 (HR) 95% 置信区间 (CI)：1.20-11.98，p=.023）。在该亚组中，诊断时的年龄较大（HR 95% CI：1.01-1.16，p=0.023）预测肝脏相关事件的风险较高。在高病毒血症组中，肝脏相关死亡率为 0.9%，并且没有患者发展为肝细胞癌。

结论：HBV DNA >2,000 IU/mL 影响居住在西欧的高加索 HBeAg 阴性患者的长期疾病结局。然而，肝脏相关事件的风险很低。

关键词：ALT；白种人；乙肝病毒DNA；乙型肝炎；非活动载体。

© Acta Gastro-Enterologica Belgica。

StephenW

A long-term study of liver-related events in Caucasian hepatitis B patients with normal ALT values and high viremia
Ö M Koc  1   2 , J Verbeek  3 , G H Koek  4   5 , R Bielen  1   6 , D Busschots  1   6 , M Gamil  3 , G Robaeys  1   6   3 , F Nevens  3
Affiliations
Affiliations

    1
    Faculty of Health and Life Sciences, Hasselt University, Diepenbeek, Belgium.
    2
    Department of Medical Microbiology, School of NUTRIM, Maastricht University Medical Centre+, Maastricht, the Netherlands.
    3
    Department of Gastroenterology and Hepatology, KU Leuven University Hospitals, Leuven, Belgium.
    4
    Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands.
    5
    Department of Surgery, University Hospital Aachen, Aachen, Germany.
    6
    Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.

    PMID: 35304994 DOI: 10.51821/85.1.9160

Abstract

Background and study aims: There is ongoing debate whether antiviral therapy should be initiated in hepatitis B e antigen (HBeAg)-negative patients with normal alanine aminotransferase (ALT) levels but high HBV DNA levels >2,000 IU/mL. Since the need for antiviral therapy might be different between Asian and Caucasian patients, we studied the long-term disease outcome in Caucasian patients living in Western Europe.

Patients and methods: One hundred sixteen patients with high HBV DNA levels (>2,000 IU/mL) at diagnosis were included in the high viremia group, while those with HBV DNA <2,000 IU/mL were used as controls (n = 327). All patients were Caucasian, HBeAg negative, had normal ALT levels and had no significant liver disease at diagnosis.

Results: Median follow-up was 7 + 9.8 years in the high viremia group and this was 10 + 12.5 years in controls. The cumulative probability of a liver-related event over 10 years was 4.8% vs 0.0% in the control group (p=.008). In multivariable analysis, high viremia group was associated with the occurrence of a liver-related event (hazards ratio (HR) 95% confidence interval (CI): 1.20-11.98, p=.023). In this subgroup, older age at diagnosis (HR 95% CI: 1.01-1.16, p=.023) predicted a higher risk of liver-related event. In the high viremia group, liver-related mortality was 0.9% and none of the patients developed hepatocellular carcinoma.

Conclusions: HBV DNA >2,000 IU/mL influences the long-term disease outcome in Caucasian HBeAg-negative patients living in Western Europe. Nevertheless, the risk of liver-related events is low.

Keywords: ALT; Caucasian; HBV DNA; hepatitis B; inactive carrier.

© Acta Gastro-Enterologica Belgica.