灰色地帶慢性乙型肝炎病毒感染患者的顯著組織學疾病

StephenW

灰色地帶慢性乙型肝炎病毒感染患者的顯著組織學疾病
王建 1 2 , 嚴曉敏 1 , 李竹 3 , 劉家成 1 4 , 邱遠望 5 , 李一光 5 , 劉依林 4 , 薛瑞飛 6 , 傑展 6 , 蘇凌江 6 , 於庚 4 , 萬亞文 7 ,李明 4 , 毛民新 4 , 高冬梅 8 , 盛夏銀 1 2 , 新同 1 2 , 夏娟 1 , 偉茂丁 8 , 陳玉新 2 9 , 傑利 1 2 , 傳武竹 3 , 黃銳 1 2 4 ,吳超 1 2 4
隸屬關係
隸屬關係

    1
    【作者單位】： 南京大學醫學院附屬醫院南京鼓樓醫院感染科;
    2
    南京大學病毒與傳染病研究所，江蘇 南京
    3
    【作者單位】： 蘇州大學附屬傳染病醫院感染科;
    4
    【作者單位】： 南京中醫藥大學南京鼓樓醫院臨床學院感染科;
    5
    【作者單位】： 無錫市第五人民醫院感染科;
    6
    【作者單位】： 南京醫科大學南京鼓樓醫院臨床學院感染科;
    7
    【作者單位】： 徐州醫科大學南京鼓樓醫院臨床學院感染科;
    8
    【作者單位】： 淮安市第四人民醫院肝內科;
    9
    【作者單位】： 南京大學醫學院附屬醫院南京鼓樓醫院檢驗科;

    PMID：36324235 DOI：10.1111/apt.17272

抽象的

背景：許多慢性乙型肝炎 (CHB) 患者不符合傳統自然期的定義，被歸類為灰色地帶 (GZ)。

目的：調查肝臟組織學，並為廣州地區的慢性乙型肝炎患者制定管理策略。

方法：本研究納入了 1043 例接受肝活檢的 CHB 患者。自然史階段是根據 AASLD 2018 乙型肝炎指南確定的。廣州地區慢性乙型肝炎患者分為HBeAg陽性、ALT正常和HBV DNA≤106 IU/ml（GZ-A）； HBeAg 陽性、ALT 升高和 HBV DNA ≤2 × 104 IU/ml (GZ-B)； HBeAg 陰性，正常 ALT 和 HBV DNA ≥2 × 103 IU/ml (GZ-C) 和 HBeAg 陰性，升高的 ALT 和 HBV DNA ≤2 × 103 IU/ml (GZ-D)。顯著的組織學疾病定義為肝臟炎症≥G2和/或肝纖維化≥S2。

結果：242 (23.2%) 名患者在廣州。大約 72.7% 的患者有明顯的組織學疾病。 HBeAg 陽性 GZ CHB 患者的顯著組織學疾病比例高於 HBeAg 陰性 GZ 患者（91.1% 對 68.5%，p = 0.002）。 GZ-D（42.6%）是主要類別，其次是GZ-C（38.8%）、GZ-A（10.3%）和GZ-B（8.3%）。 GZ-B（100.0%）中觀察到的顯著組織學疾病比例最高，其次是GZ-A（84.0%）、GZ-D（69.9%）和GZ-C（67.0%）。凝血酶原時間 (PT) 是 HBeAg 陰性 GZ 顯著組織學疾病的獨立危險因素。

結論：超過 70% 的 GZ CHB 患者有明顯的組織學疾病。我們建議對高 PT 的 HBeAg 陽性和 HBeAg 陰性 GZ CHB 患者進行抗病毒治療。

© 2022 John Wiley & Sons Ltd.

StephenW

Significant histological disease of patients with chronic hepatitis B virus infection in the grey zone
Jian Wang  1   2 , Xiaomin Yan  1 , Li Zhu  3 , Jiacheng Liu  1   4 , Yuanwang Qiu  5 , Yiguang Li  5 , Yilin Liu  4 , Ruifei Xue  6 , Jie Zhan  6 , Suling Jiang  6 , Yu Geng  4 , Yawen Wan  7 , Ming Li  4 , Minxin Mao  4 , Dongmei Gao  8 , Shengxia Yin  1   2 , Xin Tong  1   2 , Juan Xia  1 , Weimao Ding  8 , Yuxin Chen  2   9 , Jie Li  1   2 , Chuanwu Zhu  3 , Rui Huang  1   2   4 , Chao Wu  1   2   4
Affiliations
Affiliations

    1
    Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
    2
    Institute of Viruses and Infectious Diseases, Nanjing University, Nanjing, Jiangsu, China.
    3
    Department of Infectious Diseases, The Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, Jiangsu, China.
    4
    Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
    5
    Department of Infectious Diseases, The Fifth People's Hospital of Wuxi, Wuxi, Jiangsu, China.
    6
    Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
    7
    Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, Nanjing, Jiangsu, China.
    8
    Department of Hepatology, Huai'an No. 4 People's Hospital, Huai'an, Jiangsu, China.
    9
    Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.

    PMID: 36324235 DOI: 10.1111/apt.17272

Abstract

Background: Many patients with chronic hepatitis B (CHB) do not meet the definitions of the traditional natural phases and are classified as being in the grey zone (GZ).

Aims: To investigate liver histology, and to establish a management strategy for patients with CHB in the GZ.

Methods: This study included 1043 patients with CHB who underwent liver biopsy. Phases of natural history were determined according to the AASLD 2018 hepatitis B guidance. CHB patients in the GZ were divided into HBeAg-positive, normal ALT and HBV DNA ≤106 IU/ml (GZ-A); HBeAg-positive, elevated ALT and HBV DNA ≤2 × 104 IU/ml (GZ-B); HBeAg-negative, normal ALT and HBV DNA ≥2 × 103 IU/ml (GZ-C) and HBeAg-negative, elevated ALT and HBV DNA ≤2 × 103 IU/ml (GZ-D). Significant histological disease was defined as liver inflammation ≥G2 and/or liver fibrosis ≥S2.

Results: Two hundred and forty two (23.2%) patients were in the GZ. Approximately 72.7% had significant histological disease. HBeAg-positive GZ CHB patients had a higher proportion of significant histological disease than HBeAg-negative GZ patients (91.1% vs. 68.5%, p = 0.002). GZ-D (42.6%) was the dominant category, followed by GZ-C (38.8%), GZ-A (10.3%) and GZ-B (8.3%). The highest proportion of significant histological disease was observed patients in GZ-B (100.0%), followed by GZ-A (84.0%), GZ-D (69.9%) and GZ-C (67.0%). Prothrombin time (PT) was an independent risk factor of significant histological disease in the HBeAg-negative GZ.

Conclusions: Over 70% of GZ CHB patients had significant histological disease. We recommend antiviral treatment for HBeAg-positive and HBeAg-negative GZ CHB patients with high PT.

© 2022 John Wiley & Sons Ltd.