Fattovich G, Brollo L, Giustina G, Noventa F, Pontisso P, Alberti A, Realdi G, Ruol A
Istituto di Medicina Clinica, Clinica Medica 2, Università di Padova, Italy.
Gut. 1991 Mar;32(3):294-8. doi: 10.1136/gut.32.3.294.
One hundred and five hepatitis B surface antigen (HBsAg) positive patients presenting with chronic persistent hepatitis (n = 46) or chronic active hepatitis without cirrhosis (n = 59) were followed longitudinally for one to 16 years (mean 5.5 years) and underwent follow up biopsy. During a mean histological follow up of 3.7 years, active cirrhosis developed in 21 (20%) patients one to 13 years after entry to the study with a calculated annual incidence of 5.9%. The probability of evolution to cirrhosis was significantly higher in patients with chronic active hepatitis and bridging hepatic necrosis than in those with moderate chronic active hepatitis or chronic persistent hepatitis (p less than 0.0001). Cox multiple regression analysis showed that the following three variables independently implied poor prognosis: older age, presence of bridging hepatic necrosis, and persistence of hepatitis B virus DNA in serum (p less than 0.0001). These findings indicate that patients with severe chronic active hepatitis and persistent hepatitis B virus replication are at very high risk of rapid progression to cirrhosis.
105例乙肝表面抗原（HBsAg）阳性的慢性持续性肝炎患者（n = 46）或无肝硬化的慢性活动性肝炎患者（n = 59），进行了1至16年（平均5.5年）的纵向随访，并接受了随访活检。在平均3.7年的组织学随访期间，21例（20%）患者在进入研究1至13年后发展为活动性肝硬化，计算出的年发病率为5.9%。慢性活动性肝炎合并桥接性肝坏死患者发展为肝硬化的概率显著高于中度慢性活动性肝炎或慢性持续性肝炎患者（p < 0.0001）。Cox多因素回归分析显示，以下三个变量独立提示预后不良：年龄较大、存在桥接性肝坏死以及血清中乙肝病毒DNA持续存在（p < 0.0001）。这些发现表明，重度慢性活动性肝炎且乙肝病毒持续复制的患者快速进展为肝硬化的风险非常高。
