乙肝病毒基因型对西方患者慢性乙型肝炎长期预后的影响。

Influence of hepatitis B virus genotype on the long-term outcome of chronic hepatitis B in western patients.

作者信息

Sánchez-Tapias José M, Costa Josep, Mas Antoni, Bruguera Miquel, Rodés Juan

机构信息

Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona, IDIBAPS, Spain.

出版信息

Gastroenterology. 2002 Dec;123(6):1848-56. doi: 10.1053/gast.2002.37041.

DOI:10.1053/gast.2002.37041

PMID:12454842

Abstract

BACKGROUND & AIMS: The aim of this study was to investigate if the variable outcome of chronic hepatitis B may be related to hepatitis B virus (HBV) genotype.

METHODS

The clinical and virologic events observed over prolonged follow-up in 258 Spanish patients with chronic hepatitis B infected with different genotypes of HBV were compared.

RESULTS

The prevalence of genotype A, D, and F was 52%, 35%, and 7%, respectively. Concomitant sustained biochemical remission and clearance of HBV DNA occurred at a higher rate in genotype A- than in genotype D- (log-rank, 14.2; P = 0.002) or genotype F-infected patients (log-rank, 4.2; P = 0.03). The rate of hepatitis B surface antigen (HBsAg) clearance was higher in genotype A than in genotype D hepatitis (log-rank, 4.6; P = 0.03). Sustained remission and clearance of HBsAg were associated with infection with genotype A by Cox regression analysis. Seroconversion to antibody to hepatitis B e antigen (anti-HBe) was unrelated to HBV genotype, but the rate of sustained remission after seroconversion was higher in genotype A than in genotype D hepatitis both in patients who seroconverted to anti-HBe during follow-up (log-rank, 4.5; P = 0.03) and in patients with positive anti-HBe at baseline (log-rank, 6.66; P = 0.009). Death related to liver disease was more frequent in genotype F than in genotype A (P = 0.02) or genotype D (P = 0.002) hepatitis.

CONCLUSIONS

The long-term outcome of chronic hepatitis B is different in patients infected with HBV genotype A, D, or F.

摘要

背景与目的

本研究旨在探究慢性乙型肝炎的不同转归是否与乙型肝炎病毒（HBV）基因型有关。

方法

对258例感染不同基因型HBV的西班牙慢性乙型肝炎患者进行长期随访，比较观察到的临床和病毒学事件。

结果

A、D和F基因型的流行率分别为52%、35%和7%。A基因型患者同时出现持续生化缓解和HBV DNA清除的比例高于D基因型（对数秩检验，14.2；P = 0.002）或F基因型感染患者（对数秩检验，4.2；P = 0.03）。A基因型患者的乙型肝炎表面抗原（HBsAg）清除率高于D基因型肝炎患者（对数秩检验，4.6；P = 0.03）。通过Cox回归分析，持续缓解和HBsAg清除与A基因型感染有关。血清转换为乙型肝炎e抗体（抗-HBe）与HBV基因型无关，但在随访期间血清转换为抗-HBe的患者（对数秩检验，4.5；P = 0.03）以及基线抗-HBe阳性的患者中，A基因型肝炎患者血清转换后的持续缓解率均高于D基因型（对数秩检验，6.66；P = 0.009）。F基因型肝炎患者中与肝病相关的死亡比A基因型（P = 0.02）或D基因型（P = 0.002）肝炎患者更常见。