Liver Center, Huntington Medical Research Institutes, 660 South Fair Oaks Avenue, Pasadena, CA, 91105, USA.
Division of Digestive Diseases, The Pfleger Liver Institute, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Hepatol Int. 2015 Oct;9(4):567-77. doi: 10.1007/s12072-015-9651-z. Epub 2015 Jul 30.
The progression of HBsAg-positive chronic hepatitis is insidious and unpredictable. Identification of factors leading to either a benign or more serious clinical outcome may assist in decision making for antiviral therapy.
From 1989 to 1998, 130 untreated patients with chronic hepatitis were enrolled in a prospective study and followed every 3-6 months with liver and virologic tests, platelet counts and alpha-fetoprotein (AFP) measurements.
During a mean follow-up of 107 ± 86 months, 16 (12.3 %) chronic hepatitis patients progressed to cirrhosis (annual rate 1.4 %), and 23 (17.7 %) reverted to being inactive carriers (annual rate 2.1 %). Compared to baseline values, chronic hepatitis patients who progressed to cirrhosis exhibited declines in mean platelet counts (225.7-195.2 mm(3), p = 0.008-0.04) during the first 4 years of follow-up, while those who reverted to being inactive carriers had substantial reductions in mean levels of AST (83.5-27.2 u/l, p < 0.001-0.002) and ALT (100.2-29.2 u/l, p < 0.001-0.007). In addition, during spontaneous alanine aminotransferase (ALT) flares, patients progressing to cirrhosis had concomitant elevations of AFP levels, while patients who became inactive carriers maintained normal AFP values during ALT flares (13.45 vs. 4.65 ng/ml, p = 0.001). These AFP differences during episodes of ALT flares were similarly observed when analyzed in two separate cohorts of cirrhosis and inactive carrier patients.
Patients with chronic hepatitis who progressed to cirrhosis exhibited declines in platelet counts and had AFP elevations during ALT flares. To prevent progression, serial measurements of these parameters during the chronic hepatitis stage will assist in identifying patients requiring antiviral therapy.
HBsAg 阳性慢性肝炎的进展是隐匿且不可预测的。识别导致良性或更严重临床结局的因素可能有助于决策是否进行抗病毒治疗。
1989 年至 1998 年，我们纳入了 130 例未经治疗的慢性乙型肝炎患者，进行前瞻性研究，每 3-6 个月进行一次肝脏和病毒学检查、血小板计数和甲胎蛋白（AFP）检测。
平均随访 107±86 个月后，16 例（12.3%）慢性乙型肝炎患者进展为肝硬化（年发生率 1.4%），23 例（17.7%）转为非活动携带状态（年发生率 2.1%）。与基线值相比，进展为肝硬化的慢性乙型肝炎患者在随访的前 4 年内血小板计数下降（225.7-195.2mm³，p=0.008-0.04），而转为非活动携带状态的患者 AST（83.5-27.2u/l，p＜0.001-0.002）和 ALT（100.2-29.2u/l，p＜0.001-0.007）水平显著降低。此外，在自发的丙氨酸氨基转移酶（ALT）升高期间，进展为肝硬化的患者 AFP 水平升高，而成为非活动携带状态的患者在 ALT 升高期间 AFP 值保持正常（13.45 vs. 4.65ng/ml，p=0.001）。在肝硬化和非活动携带状态患者的两个独立队列中，均观察到 ALT 升高期间这些 AFP 差异。
进展为肝硬化的慢性乙型肝炎患者血小板计数下降，且在 ALT 升高期间 AFP 升高。为了防止进展，在慢性乙型肝炎阶段连续测量这些参数将有助于识别需要抗病毒治疗的患者。
