隐匿性乙型肝炎对慢性丙型肝炎病毒感染患者临床结局的影响：一项 10 年随访研究。

Impact of occult hepatitis B on the clinical outcomes of patients with chronic hepatitis C virus infection: A 10-year follow-up.

机构信息

Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.

Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

出版信息

J Formos Med Assoc. 2017 Sep;116(9):697-704. doi: 10.1016/j.jfma.2016.11.002. Epub 2016 Dec 21.

DOI:10.1016/j.jfma.2016.11.002

PMID:28012674

Abstract

BACKGROUND/PURPOSE: Occult hepatitis B infection (OHB) is not rare in countries that are endemic for hepatitis B virus (HBV) and in patients with chronic hepatitis C virus (HCV) infection. Notably, OHB has been shown to play a role in the progression of liver diseases, including the development of hepatocellular carcinoma (HCC); however, the data is inconsistent. We aim to clarify the contribution of concurrent OHB to the progression of liver diseases in a long-term cohort of patients with HCV infection and to investigate the value of total anti-hepatitis B core (anti-HBc) antibody as a surrogate OHB biomarker.

METHODS

We included 250 chronic anti-HCV-positive patients who had resolved HBV infection (anti-HBc positive and hepatitis B surface antigen negative). OHB was then detected using a sensitive commercial assay for serum HBV DNA with a low limit of detection of 6 IU/mL. Clinical outcomes, including the development of liver cirrhosis, HCC, and all-cause deaths, were compared between OHB-positive and OHB-negative patients.

RESULTS

At baseline, only 183 (73.20%) patients had positive HCV ribonucleic acid, and 56 (30.60%) of these 183 patients with active HCV infection had OHB. The presence of OHB did not correlate with any adverse clinical outcome in multivariate analyses. In addition, chronic hepatitis C patients with OHB did not have a higher level of serum total anti-HBc.

CONCLUSION

OHB infection may not contribute to the development of adverse liver outcomes in patients with chronic HCV.

摘要

背景/目的：隐匿性乙型肝炎病毒（HBV）感染在乙型肝炎病毒（HBV）流行地区和慢性丙型肝炎病毒（HCV）感染患者中并不罕见。值得注意的是，隐匿性 HBV 已被证明在肝脏疾病的进展中发挥作用，包括肝细胞癌（HCC）的发展；然而，数据并不一致。我们旨在阐明在长期 HCV 感染患者队列中，同时存在隐匿性 HBV 对肝脏疾病进展的贡献，并探讨总抗乙型肝炎核心（抗-HBc）抗体作为隐匿性 HBV 替代生物标志物的价值。

方法

我们纳入了 250 例慢性抗-HCV 阳性且已清除 HBV 感染（抗-HBc 阳性和乙型肝炎表面抗原阴性）的患者。然后使用一种敏感的商业检测试剂盒检测血清 HBV DNA，其检测下限为 6 IU/mL。比较隐匿性 HBV 阳性和隐匿性 HBV 阴性患者的临床结局，包括肝硬化、HCC 和全因死亡的发生。

结果

在基线时，只有 183 例（73.20%）患者的 HCV 核糖核酸为阳性，其中 56 例（30.60%）有活性 HCV 感染的患者存在隐匿性 HBV 感染。在多变量分析中，隐匿性 HBV 的存在与任何不良临床结局均无相关性。此外，隐匿性 HBV 感染的慢性丙型肝炎患者的血清总抗-HBc 水平并没有更高。