【慢性乙型肝炎病毒感染的自然病程及疾病进展】 [中文文章

StephenW

北京大学学宝一学班

. 2022 年 10 月 18 日；54(5):920-926。
【慢性乙型肝炎病毒感染的自然病程及疾病进展】
[中文文章]
L J Wang 1 , M W Li 2 , Y N Liu 1 , X M Chen 1 , J M Zhao 3 , S H Liu 3 , F M Lu 1 4
隶属关系
隶属关系

    1
    北京大学基础医学院微生物与传染病中心, 北京 100191
    2
    郑州大学公共卫生学院流行病学与生物统计学系, 郑州 450001
    3
    中国人民解放军总医院第五医学中心病理与肝病科,北京 100039
    4
    北京大学人民医院肝病研究所, 丙型肝炎与肝病免疫治疗北京市重点实验室, 北京 100044

    PMID: 36241234

抽象的

目的：通过对慢性 HBV 感染者的单中心大规模队列分析，更好地了解和修正慢性乙型肝炎病毒 (HBV) 感染的自然史和疾病进展。

方法：回顾性招募2014年1月至2020年10月在中国人民解放军总医院第五医学中心接受肝活检的慢性HBV感染患者。根据患者的乙型肝炎 e 抗原 (HBeAg) 状态和病理诊断，将其分为四个疾病进展状态（或按照慢性乙型肝炎 (CHB) 更新指南中的旧术语，如欧洲协会肝脏研究 (EASL) 2017，乙型肝炎病毒感染管理临床实践指南：HBeAg 阳性慢性 HBV 感染（免疫耐受）、HBeAg 阳性 CHB（免疫活性 HBeAg 阳性）、HBeAg 阴性慢性 HBV 感染（非活动携带者）和 HBeAg 阴性 CHB（免疫反应性 HBeAg 阴性）。然后比较不同疾病进展阶段患者的人口统计学、实验室检查和肝脏组织学结果。使用 Mann-Whitney U 评估两组之间的年龄差异测试。

结果：共有 760 名符合条件的患者入组，中位年龄为 29 岁（四分位距：16-39）岁。其中，未成年人（<18岁）197人，成年人563人；其中男性 456 人，女性 304 人。根据病理诊断对患者进行分类，上述四个自然病期各有173人、329人、95人、163人。进一步比较四种疾病进展状态患者的年龄，发现 HBeAg 阴性 CHB 患者的中位年龄为 37 岁，合理高于免疫活跃期 HBeAg 阳性 CHB 患者（37 vs. 24岁，P < 0.001），但比 HBeAg 阴性慢性 HBV 感染者相对年轻（37 岁对 39 岁，P = 0.240）。

结论：根据这项研究，可以推测 HBeAg 阴性 CHB 患者可能并非全部从 HBeAg 阴性慢性 HBV 感染个体重新激活。相反，某些 HBeAg 阴性 CHB 患者也可能来自 HBeAg 阳性 CHB 患者，这些患者已经经历了 HBeAg 清除或血清转换，仍处于免疫活性状态。

关键词：慢性乙型肝炎；乙型肝炎e抗原；自然历史。

StephenW

Beijing Da Xue Xue Bao Yi Xue Ban

. 2022 Oct 18;54(5):920-926.
[Natural history and disease progression of chronic hepatitis B virus infection]
[Article in Chinese]
L J Wang  1 , M W Li  2 , Y N Liu  1 , X M Chen  1 , J M Zhao  3 , S H Liu  3 , F M Lu  1   4
Affiliations
Affiliations

    1
    Department of Microbiology & Infectious Disease Center, Peking University School of Basic Medical Sciences, Beijing 100191, China.
    2
    Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China.
    3
    Department of Pathology and Hepatology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100039, China.
    4
    Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Disease, Peking University People's Hospital, Beijing 100044, China.

    PMID: 36241234

Abstract

Objective: To better understand and revise the natural history and disease progression of chronic hepatitis B virus (HBV) infection through analysis of a single-center large-scale cohort of indivi-duals with chronic HBV infection.

Methods: Patients with chronic HBV infection who had undergone liver biopsy in the Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital from January 2014 to October 2020 were retrospectively recruited. Based on patient's hepatitis B e antigen (HBeAg) states and pathologic diagnosis, they were categorized into four disease progression statuses (or phases according to the old-terminology in the updated guidelines of chronic hepatitis B (CHB), such as European Association for the Study of the Liver (EASL) 2017, Clinical Practice Guidelines on the Management of Hepatitis B Virus Infection: HBeAg-positive chronic HBV infection (immune tolerance), HBeAg-positive CHB (immune active HBeAg positive), HBeAg-negative chronic HBV infection (inactive carrier), and HBeAg-negative CHB (immune reactive HBeAg negative). Then the demographic, laboratory tests and liver histological results of the patients in different disease progression stages were compared. Age differences between the two groups were evaluated using Mann-Whitney U test.

Results: A total of 760 eligible patients with a median age of 29 (interquartile range: 16-39) years were enrolled. Among them, 197 were underage individuals (age < 18 years) and 563 were adults; and 456 were males and 304 females. According to the pathological diagnosis, the patients were classified, and in each of the above four natural disease phases there were 173, 329, 95, and 163 individuals, respectively. Further comparison of the ages of the patients of the four disease progression statuses revealed that patients of HBeAg-negative CHB had a median age at 37 years, which was reasonably higher than those with HBeAg-positive CHB in immune active phase (37 vs. 24 years, P < 0.001), but was relatively younger than those with HBeAg-negative chronic HBV infection (37 vs. 39 years, P= 0.240).

Conclusion: According to this study, it could be speculated that HBeAg-negative CHB patients probably not all reactivate from individuals of HBeAg-negative chronic HBV infection. Instead, certain HBeAg-negative CHB patients may also come from HBeAg-positive CHB patients who have undergone HBeAg clearance or seroconversion and still remain in the immune active state.

Keywords: Chronic hepatitis B; Hepatitis B e antigen; Natural history.