Abdo Ayman A, Bzeizi Khalid I, Babatin Mohammed A, AlSohaibani Fahad, AlMana Hadeel, Alsaad Khaled O, AlGhamdi Hamdan, Al-Hamoudi Waleed, AlSwat Khalid, AlFaleh Faleh Z, Myers Robert P, Sanai Faisal M
*College of Medicine, Liver Disease Research Center, King Saud University †Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary, AB, Canada ‡Department of Gastroenterology, Riyadh Military Hospital, Riyadh §Department of Medicine, Division of Gastroenterology, King Fahad General Hospital, Jeddah ∥Department of Medicine, Division of Gastroenterology ¶Department of Pathology, King Faisal Specialist Hospital & Research Center Departments of #Pathology **Hepatobiliary Sciences & Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
J Clin Gastroenterol. 2014 Jul;48(6):e50-6. doi: 10.1097/MCG.0b013e3182a9a2e1.
The data on the prevalence and predictors of significant fibrosis (≥F2, METAVIR) in chronic hepatitis B virus (HBV) patients with low viremia are limited. We aimed to assess both the prevalence predictors of ≥F2 fibrosis in hepatitis B envelope antigen-negative patients with HBV DNA <20,000 IU/mL.
Hepatitis B envelope antigen-negative patients (n=213) with mean HBV DNA <2000 IU/mL (n=97) and HBV DNA 2000 to 20,000 IU/mL (n=116) were included and all had liver biopsy. Variables significantly associated with ≥F2 fibrosis on an univariate analysis were included in a multivariate logistic regression model.
Overall, 40 (18.8%) patients had ≥F2 fibrosis, with no difference between those with mean HBV DNA <2000 IU/mL (19.6%) compared with patients with HBV DNA of 2000 to 20,000 IU/mL (18.1%; P=0.782). Fibrosis ≥F2 was similar in patients with HBV DNA <2000 versus 2000 to 20,000 IU/mL in relation to varying alanine aminotransferase thresholds (P>0.05), and was less frequent in persistently normal alanine aminotransferase patients (13.6%) when compared with those with elevated or fluctuating levels (25.3%, P=0.030). Fewer patients under 40 years of age had ≥F2 fibrosis (12.5%) as compared with older ones (28.2%; P=0.004). Logistic regression analysis identified higher aspartate aminotransferase [odds ratio (OR), 6.21; 95% confidence interval (CI), 2.48-15.54; P<0.0001], lower albumin (OR, 0.86; 95% CI, 0.78-0.95; P=0.002), platelet count (OR, 0.99; 95% CI, 0.98-0.99; P=0.013), and age (OR, 1.05; 95% CI, 1.01-1.09; P=0.024) as independent predictors of significant fibrosis.
A small but significant minority of HBV patients with low viremia harbor significant fibrosis, although its rate is not different in those with viremia above or below 2000 IU/mL. Our findings may guide in decisions regarding liver biopsy and treatment in this category of patients.
关于低病毒血症的慢性乙型肝炎病毒（HBV）患者显著纤维化（≥F2，METAVIR）的患病率及预测因素的数据有限。我们旨在评估HBV DNA<20,000 IU/mL的乙肝e抗原阴性患者中≥F2纤维化的患病率及预测因素。
纳入乙肝e抗原阴性患者（n=213），其中平均HBV DNA<2000 IU/mL者（n=97）和HBV DNA为2000至20,000 IU/mL者（n=116），所有患者均接受肝活检。单因素分析中与≥F2纤维化显著相关的变量纳入多因素逻辑回归模型。
总体而言，40例（18.8%）患者有≥F2纤维化，平均HBV DNA<2000 IU/mL的患者（19.6%）与HBV DNA为2000至20,000 IU/mL的患者（18.1%）之间无差异（P=0.782）。就不同的丙氨酸氨基转移酶阈值而言，HBV DNA<2000与2000至20,000 IU/mL的患者中≥F2纤维化情况相似（P>0.05），与丙氨酸氨基转移酶水平升高或波动的患者相比，丙氨酸氨基转移酶持续正常的患者中≥F2纤维化的发生率较低（13.6%对25.3%，P=0.030）。与年龄较大的患者相比，40岁以下的患者中≥F2纤维化的较少（12.5%对28.2%；P=0.004）。逻辑回归分析确定较高的天冬氨酸氨基转移酶[比值比（OR），6.21；95%置信区间（CI），2.48 - 15.54；P<0.0001]、较低的白蛋白（OR，0.86；95%CI，0.78 - 0.95；P=0.002）、血小板计数（OR，0.99；95%CI，0.98 - 0.99；P=0.013）和年龄（OR，1.05；95%CI，1.01 - 1.09；P=0.024）是显著纤维化的独立预测因素。
一小部分但比例可观的低病毒血症HBV患者存在显著纤维化，尽管病毒血症高于或低于2000 IU/mL的患者中其发生率无差异。我们的研究结果可能有助于指导此类患者的肝活检及治疗决策。
