慢性乙型肝炎患者肝硬化发生后的自然病程：一项长期随访研究。
Natural course following the onset of cirrhosis in patients with chronic hepatitis B: a long-term follow-up study.
机构信息
Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University, 199, Tung Hwa North Road, Taipei, 105, Taiwan,
出版信息
Hepatol Int. 2007 Mar;1(1):267-73. doi: 10.1007/s12072-007-5001-0.
PURPOSE
To elucidate the long-term natural course following the onset of cirrhosis in patients with chronic hepatitis B.
METHODS
Ninety-three patients with chronic hepatitis B who had developed cirrhosis during regular follow-up were included in this long-term follow-up study. At the time of cirrhosis detection, 30% of the patients were seropositive for hepatitis B e antigen (HBeAg) and 73% had a HBV-DNA level >10(4) copies/ml. Follow-up studies included liver biochemistry, viral markers, alpha-fetoprotein and ultrasonography every 3-6 months.
RESULTS
During a mean follow-up period of 102 +/- 60 (12-246; median 97) months, 32 patients (34.4%) experienced 55 episodes of hepatitis flare (7.0%/year), 15 (53.6%) of 28 HBeAg-positive patients seroconverted to anti-HBe (6.3%/yr) and 12 (12.9%) lost HBsAg (1.5%/year). Overall disease progression was observed in 25 (26.9%, 3.2%/year) patients: 12 (12.9%, 1.5%/year) hepatic decompensation, 21 (22.6%, 2.7%/year) hepatocellular carcinoma and 11 (11.8%, 1.4%/year) died. Multivariate analysis showed that age at onset of cirrhosis (P = 0.015) and persistent HBeAg seropositivity (P = 0.019) were the independent factors for overall disease progression.
CONCLUSIONS
These results suggest that patients with older age at onset of cirrhosis and persistent HBeAg seropositivity following the onset of cirrhosis were independent factors for the disease progression in the first 10-year after the development of cirrhosis in patients with chronic hepatitis B.
目的
阐明慢性乙型肝炎患者发生肝硬化后的长期自然病程。
方法
本长期随访研究纳入了 93 例在常规随访中发生肝硬化的慢性乙型肝炎患者。在检测到肝硬化时，30%的患者乙型肝炎 e 抗原（HBeAg）阳性，73%的患者乙型肝炎病毒脱氧核糖核酸（HBV-DNA）水平>10（4）拷贝/ml。随访研究包括每 3-6 个月进行一次肝功能检查、病毒标志物、甲胎蛋白和超声检查。
结果
在平均 102±60（12-246；中位数 97）个月的随访期间，32 例患者（34.4%）经历了 55 次肝炎发作（7.0%/年），28 例 HBeAg 阳性患者中有 15 例（53.6%）发生血清学转换（6.3%/年），12 例（12.9%）失去 HBsAg（1.5%/年）。25 例（26.9%，3.2%/年）患者出现总体疾病进展：12 例（12.9%，1.5%/年）肝失代偿，21 例（22.6%，2.7%/年）肝细胞癌，11 例（11.8%，1.4%/年）死亡。多变量分析显示，肝硬化发病时的年龄（P=0.015）和持续 HBeAg 血清阳性（P=0.019）是总体疾病进展的独立因素。
结论
这些结果表明，肝硬化发病时年龄较大和肝硬化发病后持续 HBeAg 血清阳性是慢性乙型肝炎患者发生肝硬化后 10 年内疾病进展的独立因素。
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