Xu Biao, Hu De-Chang, Rosenberg Daniel M, Jiang Qing-Wu, Lin Xi-Min, Lu Jia-Liang, Robinson Noah J
Department of Epidemiology, School of Public Health, Singapore.
J Gastroenterol Hepatol. 2003 Dec;18(12):1345-52. doi: 10.1046/j.1440-1746.2003.03187.x.
The present study aimed to describe the disease progression of chronic hepatitis B patients without or with compensated cirrhosis at baseline, to estimate the risk of progression to decompensated cirrhosis, hepatocellular carcinoma and death, and to determine prognostic factors of disease progression in patients in Shanghai, China.
Stored medical records from 322 biopsy-confirmed chronic hepatitis B cases diagnosed between 1981 and 1993 were selected, and the status of patients was tracked in 1999-2000. Among consenting patients, ultrasound examination and laboratory tests were conducted. Person-year incidence rates, Kaplan-Meier analysis, log-rank tests, and Cox regression analysis were conducted.
Among chronic hepatitis B patients without compensated cirrhosis, the incidence rates of decompensated cirrhosis, hepatocellular carcinoma, and death were 6.3, 2.8, and 7.6 per 1000 person-years, respectively, while for patients with compensated cirrhosis, the rates were 35.6, 8.2, and 35.2 per 1000 person-years, respectively. The 15-year survival rate was 88% for patients without compensated cirrhosis, compared with 56% for patients with compensated cirrhosis (P < 0.001). Cox regression analysis demonstrated that increased alpha-fetoprotein (AFP) (P < 0.01), gamma-globulin (P < 0.05), and high-level severity of hepatic fibrosis (P < 0.01) at baseline were risk factors of decompensated cirrhosis. Factors associated with a high risk of death included elevated AFP at baseline (P < 0.01), severity of hepatic fibrosis (P < 0.003), and sustained positivity for hepatitis B surface antigen (P < 0.004).
Increased AFP and severity of hepatic fibrosis at baseline were associated with higher risk of decompensated cirrhosis and death. These data provide rare empirical estimates of the negative long-term outcomes for patients with chronic hepatitis B in Shanghai, China.
本研究旨在描述基线时无代偿期肝硬化或有代偿期肝硬化的慢性乙型肝炎患者的疾病进展情况，评估进展为失代偿期肝硬化、肝细胞癌和死亡的风险，并确定中国上海患者疾病进展的预后因素。
选取1981年至1993年间经活检确诊的322例慢性乙型肝炎病例的存档病历，并于1999 - 2000年对患者状态进行追踪。在同意参与的患者中，进行了超声检查和实验室检测。进行了人年发病率、Kaplan - Meier分析、对数秩检验和Cox回归分析。
在无代偿期肝硬化的慢性乙型肝炎患者中，失代偿期肝硬化、肝细胞癌和死亡的发病率分别为每1000人年6.3、2.8和7.6例，而有代偿期肝硬化的患者发病率分别为每1000人年35.6、8.2和35.2例。无代偿期肝硬化患者的15年生存率为88%，有代偿期肝硬化患者为56%（P < 0.001）。Cox回归分析表明，基线时甲胎蛋白（AFP）升高（P < 0.01）、γ球蛋白升高（P < 0.05）以及肝纤维化高度严重（P < 0.01）是失代偿期肝硬化的危险因素。与高死亡风险相关的因素包括基线时AFP升高（P < 0.01）、肝纤维化严重程度（P < 0.003）以及乙肝表面抗原持续阳性（P < 0.004）。
基线时AFP升高和肝纤维化严重程度与失代偿期肝硬化和死亡的较高风险相关。这些数据为中国上海慢性乙型肝炎患者的长期不良结局提供了罕见的实证估计。
