Department of Hepatogastroenterology, Hôpital de Jolimont, Haine-Saint-Paul, Belgium.
Eur J Gastroenterol Hepatol. 2013 May;25(5):613-9. doi: 10.1097/MEG.0b013e32835d83a2.
Nationwide studies comparing patients with hepatitis B and C virus (HBV and HCV) infections are mandatory for assessing changes in epidemiology.
The aim of this study was to compare epidemiological data and initial management of newly diagnosed patients with persistent HBV (HBsAg positive) or HCV (detectable HCV RNA) infection in Belgium.
Data were extracted from two Belgian observational databases.
A total of 655 patients (387 HBV and 268 HCV) were included. Compared with HCV patients, HBV patients were younger, more frequently men, more often of Asian or African origin (43 vs. 10%, P<0.0001), and less frequently contaminated by transfusion or intravenous drug use (9 and 6% vs. 34 and 44%, P<0.0001). Viral replication was assessed in 89% of HBV patients. Compared with HCV patients, HBV patients more frequently had normal alanine aminotransferase (ALT) levels (65 vs. 29%, P<0.0001), less frequently underwent liver biopsy (29 vs. 67%, P<0.0001), and were less often considered for antiviral therapy (25 vs. 54%, P<0.0001). When taking only HBV patients with detectable viral replication into consideration, results remained unchanged. During the multivariate analysis, ALT was a major factor for performing liver biopsy or considering antiviral therapy in both groups.
HBV and HCV screening policies should be targeted toward immigrants and intravenous drug users, respectively. Guidelines recommending systematic search for viral replication should be reinforced in HBV patients. HBV patients less frequently underwent liver biopsy and were less often considered for antiviral therapy compared with HCV patients. Despite the lack of sensitivity and specificity, ALT remains a pivotal decision-making tool for liver biopsy and antiviral therapy in both infections.
进行全国性的乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染患者比较研究对于评估流行病学变化是强制性的。
本研究旨在比较比利时新诊断的持续性 HBV（HBsAg 阳性）或 HCV（可检测到 HCV RNA）感染患者的流行病学数据和初始管理。
数据从两个比利时观察性数据库中提取。
共纳入 655 例患者（387 例 HBV 和 268 例 HCV）。与 HCV 患者相比，HBV 患者更年轻，更多为男性，更多来自亚洲或非洲（43%比 10%，P<0.0001），更少因输血或静脉吸毒而受污染（9%比 34%和 6%比 44%，P<0.0001）。89%的 HBV 患者评估了病毒复制。与 HCV 患者相比，HBV 患者更常出现正常丙氨酸氨基转移酶（ALT）水平（65%比 29%，P<0.0001），更少进行肝活检（29%比 67%，P<0.0001），更少考虑抗病毒治疗（25%比 54%，P<0.0001）。仅考虑可检测到病毒复制的 HBV 患者时，结果保持不变。在多变量分析中，ALT 是两组进行肝活检或考虑抗病毒治疗的主要因素。
HBV 和 HCV 筛查政策应分别针对移民和静脉吸毒者。应加强针对 HBV 患者的系统寻找病毒复制的指南。与 HCV 患者相比，HBV 患者较少进行肝活检，较少考虑抗病毒治疗。尽管缺乏敏感性和特异性，ALT 仍然是两种感染中肝活检和抗病毒治疗的关键决策工具。
