Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
Clin Gastroenterol Hepatol. 2009 Dec;7(12):1361-6. doi: 10.1016/j.cgh.2009.08.004. Epub 2009 Aug 13.
BACKGROUND & AIMS: Histologic analyses of liver fibrosis have been limited by small sample sizes and the predominance of samples from patients with active hepatitis.
We performed a prospective study of transient elastography in treatment-naive patients with chronic hepatitis B, to investigate the relationship between hepatitis B virus (HBV) genotype and liver fibrosis. A validated liver stiffness measurement algorithm was used to define insignificant fibrosis and advanced fibrosis.
Of 1106 patients, 711 (64%) were older than age 40, 370 (34%) had positive test results for hepatitis B e antigen (HBeAg), and 386 (35%) had increased serum levels of alanine aminotransferase. Of the patients, 524 (49%) had genotype B and 582 (51%) had genotype C HBV infection. Patients with genotype C infection had insignificant fibrosis less often (42% vs 55%; P < .0001) and advanced fibrosis more often (25% vs 19%; P = .015) than those infected with genotype B HBV. The difference in the severity of liver fibrosis between the 2 HBV genotypes was most marked among patients older than age 40 and those who tested negative for HBeAg. The mean age of patients infected by genotype C was greater than that of patients infected by genotype B HBV (41 vs 36 y). Among patients who were older than age 40 and tested negative for HBeAg, those with genotype C infection had higher levels of HBV DNA and alanine aminotransferase than those with genotype B HBV.
Genotype C HBV was associated with more severe liver fibrosis than genotype B HBV, probably because of delayed HBeAg seroconversion and prolonged active disease.
肝纤维化的组织学分析受到样本量小和主要为活动期肝炎患者样本的限制。
我们对未经治疗的慢性乙型肝炎患者进行了瞬时弹性成像的前瞻性研究，以研究乙型肝炎病毒（HBV）基因型与肝纤维化之间的关系。使用经过验证的肝硬度测量算法来定义无显著纤维化和进展性纤维化。
在 1106 例患者中，711 例（64%）年龄大于 40 岁，370 例（34%）乙型肝炎 e 抗原（HBeAg）检测结果阳性，386 例（35%）血清丙氨酸氨基转移酶水平升高。患者中 524 例（49%）为基因型 B，582 例（51%）为基因型 C HBV 感染。基因型 C 感染患者无显著纤维化的发生率较低（42%比 55%；P <.0001），进展性纤维化的发生率较高（25%比 19%；P =.015）。2 种 HBV 基因型之间肝纤维化严重程度的差异在年龄大于 40 岁和 HBeAg 阴性的患者中最为明显。基因型 C 感染患者的平均年龄大于基因型 B HBV 感染患者（41 岁比 36 岁）。在年龄大于 40 岁和 HBeAg 阴性的患者中，基因型 C 感染患者的 HBV DNA 和丙氨酸氨基转移酶水平高于基因型 B HBV 感染患者。
基因型 C HBV 与更严重的肝纤维化相关，可能是因为 HBeAg 血清学转换延迟和持续的活动性疾病。
