Lin Ximin, Robinson Noah J, Thursz Mark, Rosenberg Daniel M, Weild Andrew, Pimenta Jeanne M, Hall Andrew J
Department of Epidemiology, School of Public Health, Fudan University Medical Center, Shanghai, China.
J Gastroenterol Hepatol. 2005 Jun;20(6):833-43. doi: 10.1111/j.1440-1746.2005.03813.x.
Countries in the the Asia-Pacific region and Africa tend to have the highest prevalence of hepatitis B infection worldwide. Hepatitis B infection progresses from an asymptomatic persistently infected status to chronic hepatitis B, cirrhosis, decompensated liver disease and/or hepatocellular carcinoma. The aim of this review was to summarize rates and risk factors for progression between disease states in the Asia-Pacific region and Africa. A literature search was conducted employing MEDLINE and EMBASE (1975-2003) using the following key words: hepatitis B, natural history, disease progression, cirrhosis, hepatocellular carcinoma, mortality, Africa and the Asia-Pacific region. Bibliographies of articles reviewed were also searched. Ranges for annual progression rates were: (i) asymptomatic persistent infection to chronic hepatitis B, 0.84-2.7%; (ii) chronic hepatitis B to cirrhosis, 1.0-2.4%; and (iii) cirrhosis to hepatocellular carcinoma, 3.0-6.6%. Patients with asymptomatic persistent infection and chronic hepatitis B had relatively low 5-year mortality rates (<4%); rates (>50%) were much higher in patients with decompensated liver disease and hepatocellular carcinoma. No data were found for progression rates in African populations. Hepatitis B e antigen was a risk factor for chronic hepatitis B, and bridging hepatic necrosis in chronic hepatitis B increased the risk of cirrhosis. Risk factors for hepatocellular carcinoma included cirrhosis, co-infection with hepatitis C virus, and genetic and environmental factors. In this review, wide ranges of disease progression estimates are documented, emphasizing the need for further studies, particularly in Africa, where progression rates are largely not available. Summarizing information on factors associated with disease progression should assist in focusing efforts to arrest the disease process in those at most risk.
亚太地区和非洲国家的乙肝感染率在全球往往是最高的。乙肝感染会从无症状持续感染状态发展为慢性乙肝、肝硬化、失代偿性肝病和/或肝细胞癌。本综述的目的是总结亚太地区和非洲疾病状态之间进展的发生率及危险因素。使用MEDLINE和EMBASE（1975 - 2003年）进行文献检索，关键词如下：乙肝、自然史、疾病进展、肝硬化、肝细胞癌、死亡率、非洲和亚太地区。还检索了所审查文章的参考文献。年进展率范围如下：（i）无症状持续感染至慢性乙肝，0.84 - 2.7%；（ii）慢性乙肝至肝硬化，1.0 - 2.4%；（iii）肝硬化至肝细胞癌，3.0 - 6.6%。无症状持续感染和慢性乙肝患者的5年死亡率相对较低（<4%）；失代偿性肝病和肝细胞癌患者的死亡率（>50%）则高得多。未找到非洲人群进展率的数据。乙肝e抗原是慢性乙肝的一个危险因素，慢性乙肝中的桥接坏死增加了肝硬化的风险。肝细胞癌的危险因素包括肝硬化、丙型肝炎病毒合并感染以及遗传和环境因素。在本综述中，记录了疾病进展估计的广泛范围，强调需要进一步研究，特别是在非洲，那里的进展率大多未知。总结与疾病进展相关的因素信息应有助于集中努力，以阻止处于最高风险人群的疾病进程。
