慢性乙型肝炎中国患者自发HBeAg血清学转换后持续的疾病缓解与纤维化进展的降低相关。
Sustained disease remission after spontaneous HBeAg seroconversion is associated with reduction in fibrosis progression in chronic hepatitis B Chinese patients.
作者信息
Hui Chee-Kin, Leung Nancy, Shek Tony W H, Yao Hung, Lee Wai-Ki, Lai Jak-Yiu, Lai Sik-To, Wong Wai-Man, Lai Lawrence S W, Poon Ronnie T P, Lo Chung-Mau, Fan Sheung-Tat, Lau George K K
机构信息
Department of Medicine,University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region (SAR), China.
出版信息
Hepatology. 2007 Sep;46(3):690-8. doi: 10.1002/hep.21758.
UNLABELLED
Recently, controversies have arisen about whether hepatitis B e antigen (HBeAg) seroconversion can result in regression of fibrosis, thus improving the clinical outcome of Chinese patients with chronic hepatitis B. In this study, we determined if spontaneous HBeAg seroconversion is associated with regression of fibrosis in Chinese chronic hepatitis B patients. We evaluated the histology of liver samples from 128 HBeAg-positive treatment-naive Chinese patients who had undergone 2 liver biopsies over the years. Regression of fibrosis was defined as a decrease in fibrosis stage of at least 1 point. Sustained disease remission was defined as HBeAg seroconversion and hepatitis B virus (HBV) DNA < 10(4) copies/ml at follow-up liver biopsy. The mean duration (+/- standard error of the mean) between the initial and follow-up liver biopsies was 43.9 +/- 3.4 months. Regression of fibrosis was higher in patients with sustained disease remission (5 of 13 [38.5%] versus 22 of 115 [19.1%], P < 0.00005), patients who were younger (20-29 years old) at initial liver biopsy (17 of 54 [31.5%] versus 10 of 74 [13.5%], P = 0.0004), and patients with genotype B (17 of 43 [39.5%] versus 10 of 85 [11.8%], P = 0.004). On multivariate analysis, sustained disease remission (relative risk [RR] 3.00, 95% confidence interval [95% CI] 1.29-7.01, P = 0.01) and being 20-29 years old at initial liver biopsy (RR 2.94, 95% CI 1.01-8.62, P = 0.04) were independently associated with regression of fibrosis. The rate of fibrosis progression was lower in patients with sustained disease remission than in those who remained HBeAg positive (median 0 fibrosis units/year, range -2.00 to -0.70 fibrosis units/year, versus median 0.51 fibrosis units/year, range 0 to +2.03 fibrosis units/year, P = 0.02).
CONCLUSION
Spontaneous sustained remission of disease is associated not only with little progression of fibrosis but also with regression of fibrosis.
未标记
最近，关于乙肝e抗原（HBeAg）血清学转换是否能导致肝纤维化消退从而改善中国慢性乙型肝炎患者的临床结局，引发了争议。在本研究中，我们确定了中国慢性乙型肝炎患者中HBeAg自发血清学转换是否与肝纤维化消退相关。我们评估了128例未接受过治疗的HBeAg阳性中国患者多年来的2次肝脏活检样本的组织学情况。肝纤维化消退定义为纤维化分期至少降低1分。持续疾病缓解定义为在随访肝脏活检时HBeAg血清学转换且乙肝病毒（HBV）DNA<10⁴拷贝/ml。初次和随访肝脏活检之间的平均持续时间（±平均标准误差）为43.9±3.4个月。持续疾病缓解的患者肝纤维化消退率更高（13例中的5例[38.5%]对115例中的22例[19.1%]，P<0.00005），初次肝脏活检时年龄较轻（20 - 29岁）的患者（54例中的17例[31.5%]对74例中的10例[13.5%]），以及B基因型患者（43例中的17例[39.5%]对85例中的10例[11.8%]，P = 0.004）。多因素分析显示，持续疾病缓解（相对风险[RR]3.00，95%置信区间[95%CI]1.29 - 7.01，P = 0.01）和初次肝脏活检时年龄为20 - 29岁（RR 2.94，9对持续疾病缓解的患者，肝纤维化进展率低于仍为HBeAg阳性的患者（中位数0纤维化单位/年，范围 - 2.00至 - 0.70纤维化单位/年，对中位数0.51纤维化单位/年，范围0至 + 2.03纤维化单位/年，P = 0.02）。
结论
疾病的自发持续缓解不仅与肝纤维化进展缓慢有关，还与肝纤维化消退有关。
%CI]1.01 - 8.62，P = 0.04）与肝纤维化消退独立相关。
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