HBV DNA 水平波动的低病毒血症乙型肝炎患者肝纤维化患病率较

StephenW

HBV DNA 水平波动的低病毒血症乙型肝炎患者肝纤维化患病率较低
Faisal M Sanai 1 , Ahmad H Alhouthali 1 , Hamdan S Alghamdi 2 , Feras Badriq 3 , Eisa A Sanai 1 , Mohammed K Mujalled 1 , Waleed Khayyat 3 , Motaz S Attar 3 , Basil S Bagadeem 3 , Alaa M Meer 1 , Waleed Alshumrani 4、Khalid Albeladi 1、易卜拉欣 AlTraif 2、Saleh Alqahtani 5
隶属关系
隶属关系

    1
    沙特阿拉伯吉达阿卜杜勒阿齐兹国王医疗城胃肠病学部内科。
    2
    沙特·本·阿卜杜勒阿齐兹国王健康科学大学医学院，阿卜杜拉国王国际医学研究中心，国民警卫队卫生事务部，吉达；沙特阿拉伯利雅得阿卜杜勒阿齐兹国王医疗城肝胆科和器官移植中心。
    3
    沙特·本·阿卜杜勒阿齐兹国王健康科学大学医学院，阿卜杜拉国王国际医学研究中心，国民警卫队卫生事务部，沙特阿拉伯吉达。
    4
    吉达阿卜杜勒阿齐兹国王医疗城胃肠病科内科；沙特·本·阿卜杜勒阿齐兹国王健康科学大学医学院，阿卜杜拉国王国际医学研究中心，国民警卫队卫生事务部，沙特阿拉伯吉达。
    5
    沙特阿拉伯利雅得费萨尔国王专科医院和研究中心肝移植中心；美国马里兰州巴尔的摩市约翰霍普金斯大学胃肠病学和肝病学系。

    PMID：35488588 DOI：10.4103/sjg.sjg_48_22

抽象的

背景：在慢性乙型肝炎病毒（HBV）患者中，HBV DNA 的波动充当“灰色区域”，阻碍了对非活动携带者的准确识别。我们旨在评估这种波动是否会影响慢性 HBV 患者中显着肝纤维化（Metavir F2-4）的存在。

方法：纳入连续、未经治疗的 HBeAg 阴性携带者 (n = 234)，其 HBV DNA (n = 73) 波动高于或低于 2000 IU/mL 水平，并与没有波动的那些 (n = 161) 进行比较。根据持续低（<2,000 IU/mL，n = 137）和更高 HBV DNA（2,000-20,000 IU/mL，n = 24）的患者，进一步分析没有 HBV DNA 波动的患者。肝纤维化（通过瞬时弹性成像评估）与病毒学和生化特征相关。

结果：整个队列的平均年龄为 47.8 ± 11.1 岁，其中 107 人 (45.7%) 为男性。在中位 60 个月（四分位距 [IQR] 34-82）的随访期间，73 名（31.2%）患者的 HBV DNA 平均波动为 1.6 ± 0.9。第一次波动的中位时间为 14.5 (IQR 5.0-33.7) 个月。与没有波动的患者相比，波动病毒血症患者的 log10 qHBsAg (3.1 ± 0.8 vs. 2.7 ± 1.0, P = 0.022) 和 HBV DNA (3.4 ± 0.5 vs. 2.7 ± 0.8, P < 0.001) 更高。与没有波动性病毒血症的患者相比，波动性病毒血症患者发生 F2-4 纤维化的可能性较低（8.2%）（18.2%，优势比 [OR]：0.407，95% 置信区间 [CI]：0.161-1.030；P = 0.052 ）。男性波动较小，占 HBV DNA 波动患者的 37.0%（P = 0.071）。与没有波动的人相比（14.9%；P = 0.030），HBV DNA 水平明显较高的人（26.0%）发生波动的频率更高。

结论：波动的 HBV DNA 水平经常发生，但与明显的纤维化无关。 HBV DNA 水平的微小波动不太可能具有临床相关性。

关键词：波动；乙肝病毒DNA；灰色地带；乙型肝炎；不活跃的运营商；显着纤维化；病毒血症。

StephenW

Lower prevalence of hepatic fibrosis in low viremic hepatitis B patients with fluctuating HBV DNA levels
Faisal M Sanai  1 , Ahmad H Alhouthali  1 , Hamdan S Alghamdi  2 , Feras Badriq  3 , Eisa A Sanai  1 , Mohammed K Mujalled  1 , Waleed Khayyat  3 , Motaz S Attar  3 , Basil S Bagadeem  3 , Alaa M Meer  1 , Waleed Alshumrani  4 , Khalid Albeladi  1 , Ibrahim AlTraif  2 , Saleh Alqahtani  5
Affiliations
Affiliations

    1
    Department of Medicine, Gastroenterology Unit, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
    2
    College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah; Department of Hepatobiliary Sciences and Organ Transplant Center, Division of Hepatology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
    3
    College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.
    4
    Department of Medicine, Gastroenterology Unit, King Abdulaziz Medical City, Jeddah; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.
    5
    Liver Transplant Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, United States.

    PMID: 35488588 DOI: 10.4103/sjg.sjg_48_22

Abstract

Background: In chronic hepatitis B virus (HBV) patients, fluctuations in HBV DNA serve as a "gray area" and impede the accurate identification of inactive carriers. We aimed to assess if such fluctuations impact the presence of significant hepatic fibrosis (Metavir F2-4) in chronic HBV patients.

Methods: Consecutive, untreated HBeAg-negative carriers (n = 234) with fluctuating HBV DNA (n = 73) above or below a level of 2000 IU/mL were included and compared to those without fluctuations (n = 161). Patients without fluctuating HBV DNA were further analyzed based on those with persistently low (<2,000 IU/mL, n = 137) and higher HBV DNA (2,000-20,000 IU/mL, n = 24). Hepatic fibrosis (assessed by transient elastography) was correlated with virologic and biochemical profiles.

Results: The mean age of the overall cohort was 47.8 ± 11.1 years, of whom 107 (45.7%) were male. During a median of 60 months (interquartile range [IQR] 34-82) of follow-up, 73 (31.2%) patients had a mean of 1.6 ± 0.9 fluctuations in HBV DNA. The median time to the first fluctuation was at 14.5 (IQR 5.0-33.7) months. Patients with fluctuating viremia had higher log10 qHBsAg (3.1 ± 0.8 vs. 2.7 ± 1.0, P = 0.022) and HBV DNA (3.4 ± 0.5 vs. 2.7 ± 0.8, P < 0.001) compared to those without fluctuations. Patients with fluctuant viremia were less likely to have F2-4 fibrosis (8.2%) compared to those without fluctuant viremia (18.2%, odds ratio [OR]: 0.407, 95% confidence interval [CI]: 0.161-1.030; P = 0.052). Males tended to have less fluctuation constituting 37.0% of patients with fluctuating HBV DNA (P = 0.071). Fluctuations occurred more frequently in those with predominantly higher HBV DNA levels (26.0%) compared to those without fluctuations (14.9%; P = 0.030).

Conclusions: Fluctuating HBV DNA levels occur frequently but are not associated with significant fibrosis. Minor fluctuations in HBV DNA levels are unlikely to be of clinical relevance.

Keywords: Fluctuation; HBV DNA; gray zone; hepatitis B; inactive carriers; significant fibrosis; viremia.