Division of Viral Hepatitis, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Henry Ford Health System, Detroit, MI, USA.
Aliment Pharmacol Ther. 2016 Nov;44(10):1080-1089. doi: 10.1111/apt.13802. Epub 2016 Sep 19.
Limited information exists regarding the distribution of disease phases, treatment prescription and severe liver disease among patients with chronic hepatitis B (CHB) in US general healthcare settings.
To determine the distribution of disease phases, treatment prescription and severe liver disease among patients with CHB in general US healthcare settings.
We analysed demographic and clinical data collected during 2006-2013 from patients with confirmed CHB in the Chronic Hepatitis Cohort Study, an observational cohort study involving patients from healthcare organisations in Michigan, Pennsylvania, Oregon and Hawaii. CHB phases were classified according to American Association for the Study of Liver Disease guidelines.
Of 1598 CHB patients with ≥12 months of follow-up (median 6.3 years), 457 (29%) were immune active during follow-up [11% hepatitis B e antigen (HBeAg)-positive, 16% HBeAg-negative, and 2% HBeAg status unknown], 10 (0.6%) were immune tolerant, 112 (7%) were inactive through the duration of follow-up and 886 (55%) were phase indeterminate. Patients with cirrhosis were identified within each group (among 21% of immune active, 3% of inactive and 9% of indeterminate phase patients) except among those with immune-tolerant CHB. Prescription of treatment was 59% among immune active patients and 84% among patients with cirrhosis and hepatitis B virus (HBV) DNA >2000 IU/mL.
Approximately, one-third of the cohort had active disease during follow-up; 60% of eligible patients were prescribed treatment. Our findings underscore the importance of ascertainment of fibrosis status in addition to regular assessment of ALT and HBV DNA levels.
在美国常规医疗保健环境中，有关慢性乙型肝炎（CHB）患者疾病阶段、治疗方案和严重肝脏疾病的分布信息有限。
确定美国常规医疗保健环境中 CHB 患者的疾病阶段、治疗方案和严重肝脏疾病的分布情况。
我们分析了 2006 年至 2013 年期间在慢性丙型肝炎队列研究中确诊为 CHB 的患者的人口统计学和临床数据，该观察性队列研究涉及密歇根州、宾夕法尼亚州、俄勒冈州和夏威夷的医疗保健机构的患者。根据美国肝病研究协会指南对 CHB 阶段进行分类。
在 1598 例有≥12 个月随访（中位随访时间为 6.3 年）的 CHB 患者中，457 例（29%）在随访期间处于免疫激活期[11%乙型肝炎 e 抗原（HBeAg）阳性、16%HBeAg 阴性和 2%HBeAg 状态未知]，10 例（0.6%）处于免疫耐受期，112 例（7%）在整个随访期间处于非活动期，886 例（55%）处于阶段不确定期。除免疫耐受 CHB 患者外，在每个组中均发现了肝硬化患者（在免疫激活组中占 21%、在非活动组中占 3%、在不确定期组中占 9%）。免疫激活患者中治疗处方率为 59%，肝硬化和乙型肝炎病毒（HBV）DNA>2000IU/ml 的患者中治疗处方率为 84%。
大约三分之一的队列在随访期间患有活动期疾病；60%的合格患者接受了治疗。我们的研究结果强调了除了定期评估 ALT 和 HBV DNA 水平外，还需要确定纤维化状态的重要性。
