慢性乙型肝炎病毒感染自然过程中的肝纤维化：荟萃分析的

StephenW

慢性乙型肝炎病毒感染自然过程中的肝纤维化：荟萃分析的系统评价

    林美红、李海琼、朱琳、苏海英、彭丽珊、王创元、何才平、梁谢尔和王艳

消化系统疾病和科学第 67 卷，第 2608–2626 页（2022 年）引用这篇文章

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抽象的
背景

慢性HBV感染（CHB）患者肝纤维化自然病程的定量数据有限。
目标

估计在 CHB 的整个自然过程中纤维化状态的患病率，包括非纤维化、显着纤维化、晚期纤维化和肝硬化。
方法

我们检索了 1993 年 1 月至 2019 年 11 月期间的 Cochrane 图书馆、EMBASE、PubMed、SCOPUS、Web of Science 和 ScienceDirect，以获取有关 CHB 自然病程中肝纤维化组织学数据的研究。 CHB 病程是根据国际临床实践指南推荐的确定感染阶段的现行标准定义的，包括 HBeAg 阳性免疫耐受、HBeAg 阳性免疫活性、HBeAg 阴性免疫无活性、HBeAg 阴性免疫反应、和 HBsAg 阴性阶段。从随机效应荟萃分析中获得每个阶段纤维化状态的汇总患病率。
结果

有 9,377 名成年参与者（23.8-49.0 岁；45.5-88.6% 男性）的 33 项研究符合条件并最终纳入。对于 HBeAg 阳性免疫耐受期，非纤维化、显着纤维化、晚期纤维化和肝硬化的估计患病率为：31.2% (95%CI 15.6–46.7)、16.9% (95%CI 7.8–26.1)、5.4 % (95%CI 0.0–11.2) 和 0.0% (95%CI 0.0–1.5)； HBeAg 阳性免疫活性期：6.9% (95%CI 3.6–10.2)、50.6% (95%CI 39.2–61.9)、32.1% (95%CI 24.2–40.0) 和 12.8% (95%CI 8.6– 17.0); HBeAg 阴性免疫非活动期：32.4% (95%CI 0.0–100.0)、24.8% (95%CI 4.5–45.1)、3.0% (95%CI 0.0–8.3) 和 0.0% (95%CI 0.0– 1.0);和 HBeAg 阴性免疫反应期：6.3% (95%CI 3.5–9.2)、50.3% (95%CI 38.9–61.7)、30.3% (95%CI 20.9–39.6) 和 10.0% (95%CI 6.6) –13.5)，分别。只有一项针对 HBsAg 阴性期的研究，因此不允许进一步的荟萃分析。
结论

通过 CHB 自然病程，纤维化风险持续存在。这些数据可以支持临床实践中的风险评估，为无创研究提供参考。

StephenW

Liver Fibrosis in the Natural Course of Chronic Hepatitis B Viral Infection: A Systematic Review with Meta-Analysis

    Mei-Hong Lin, Hai-Qiong Li, Lin Zhu, Hai-Ying Su, Li-Shan Peng, Chuang-Yuan Wang, Cai-Ping He, Xie-Er Liang & Yan Wang

Digestive Diseases and Sciences volume 67, pages 2608–2626 (2022)Cite this article

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Abstract
Background

Quantitative data are limited on the natural course of liver fibrosis in patients with chronic HBV infection (CHB).
Aims

To estimate the prevalence of fibrosis status including non-fibrosis, significant fibrosis, advanced fibrosis, and cirrhosis throughout the natural course of CHB.
Methods

We searched Cochrane library, EMBASE, PubMed, SCOPUS, Web of Science, and ScienceDirect from January 1993 to November 2019 for studies with histologic data on liver fibrosis in CHB natural course. CHB course was defined based on current criteria for identifying infection phases as recommended by international clinical practice guidelines, including the HBeAg-positive immune-tolerant, HBeAg-positive immune-active, HBeAg-negative immune-inactive, HBeAg-negative immune-reactive, and HBsAg-negative phases. Pooled prevalence rate of fibrosis status at each phase was obtained from random-effect meta-analyses.
Results

Thirty-three studies with 9,377 adult participants (23.8–49.0 age years; 45.5–88.6% males) were eligible and finally included. The estimated prevalence of non-fibrosis, significant fibrosis, advanced fibrosis, and cirrhosis was, for HBeAg-positive immune-tolerant phase: 31.2% (95%CI 15.6–46.7), 16.9% (95%CI 7.8–26.1), 5.4% (95%CI 0.0–11.2), and 0.0% (95%CI 0.0–1.5); HBeAg-positive immune-active phase: 6.9% (95%CI 3.6–10.2), 50.6% (95%CI 39.2–61.9), 32.1% (95%CI 24.2–40.0), and 12.8% (95%CI 8.6–17.0); HBeAg-negative immune-inactive phase: 32.4% (95%CI 0.0–100.0), 24.8% (95%CI 4.5–45.1), 3.0% (95%CI 0.0–8.3), and 0.0% (95%CI 0.0–1.0); and HBeAg-negative immune-reactive phase: 6.3% (95%CI 3.5–9.2), 50.3% (95%CI 38.9–61.7), 30.3% (95%CI 20.9–39.6), and 10.0% (95%CI 6.6–13.5), respectively. There was only one study for HBsAg-negative phase, thus not allowing further meta-analyses.
Conclusions

Fibrosis risk persists through CHB natural course. These data can support risk estimation in clinical practice and provide reference for noninvasive investigation.