Couto Ingrid, Victoria Marilu, Veloso Valdiléa G, Rodrigues Lorena, Grinsztejn Beatriz, Lacerda Marcus, Victoria Flamir, Perazzo Hugo
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT HVD), Manaus, Amazonas, Brazil.
Laboratório de Pesquisa Clínica em DST/AIDS (LAPCLIN-AIDS), Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
PLoS One. 2017 Mar 22;12(3):e0174453. doi: 10.1371/journal.pone.0174453. eCollection 2017.
The study aimed to evaluate the prevalence and predictor factors for compensated advanced chronic liver disease (c-ACLD) in patients with hepatitis Delta virus (HDV) infection.
This cross-sectional study included consecutive HDV-infected patients defined by positive anti-HDV. Patients with hepatitis C coinfection, liver transplantation or presence of conditions that limit liver (LSM) or spleen stiffness measurement (SSM) were excluded. Blood tests, abdominal ultrasound, SSM and LSM by transient elastography (FibroScan®) were performed at the same day. Alcohol consumption was quantified using the AUDIT score and c-ACLD was defined by LSM ≥ 15 kPa performed by an experimented operator blinded for clinical and laboratory data.
101 patients were eligible and few patients were excluded due to negative anti-HDV (n = 7), hepatitis C coinfection (n = 2), liver transplantation (n = 10) and limitation for LSM or SSM (n = 5). Therefore, 77 patients [61% male, age = 43 (IQR,36-52) years] were included. The prevalence of c-ACLD was 57% (n = 44/77). Patients with c-ACLD had a higher rate of detectable HBV viral load (p = 0.039), higher levels of transaminases, GGT, alkaline phosphatases, total bilirubin and INR (p<0.001 for all), as well as lower platelet count and albumin levels (p>0.001 for both) compared to those without c-ACLD. Patients with c-ACLD had higher SSM [65.2 (IQR,33.8-75.0) vs 21.8 (16.5-32.0) kPa; p<0.001] and higher splenic volume [475 (IQR,311-746) vs 154 (112-283) cm3; p<0.001] compared to those without. Detectable HBV viral load (>10 UI/ml), alkaline phosphatase (per IU/L) and GGT levels (per IU/L) were independently associated with c-ACLD in all multivariate models. Splenic volume [per cm3,OR = 1.01 (95%CI,1.01-1.02);p = 0.002], SSM [per kPa, OR = 1.04 (1.01-1.07);p = 0.012] and splenomegaly [yes vs no,OR = 28.45 (4.42-182.95);p<0.001] were independently associated with c-ACLD.
The prevalence of c-ACLD was high in patients with chronic HDV infection in western Amazon basin. HBV viral load, liver enzymes and splenic features can be used to predict severe liver disease in HDV-infected patients.
本研究旨在评估丁型肝炎病毒（HDV）感染患者中代偿期晚期慢性肝病（c-ACLD）的患病率及预测因素。
这项横断面研究纳入了抗-HDV阳性的连续性HDV感染患者。排除丙型肝炎合并感染、肝移植患者或存在限制肝脏硬度测量（LSM）或脾脏硬度测量（SSM）情况的患者。在同一天进行血液检查、腹部超声、通过瞬时弹性成像（FibroScan®）进行SSM和LSM。使用酒精使用障碍识别测试（AUDIT）评分对酒精摄入量进行量化，c-ACLD由对临床和实验室数据不知情的经验丰富的操作人员通过LSM≥15 kPa来定义。
101例患者符合条件，少数患者因抗-HDV阴性（n = 7）、丙型肝炎合并感染（n = 2）、肝移植（n = 10）以及LSM或SSM受限（n = 5）而被排除。因此，纳入了77例患者[男性占61%，年龄为43（四分位间距，36 - 52）岁]。c-ACLD的患病率为57%（n = 44/77）。与无c-ACLD的患者相比，c-ACLD患者的可检测HBV病毒载量率更高（p = 0.039），转氨酶、γ-谷氨酰转移酶（GGT）、碱性磷酸酶、总胆红素和国际标准化比值（INR）水平更高（所有p<0.001），血小板计数和白蛋白水平更低（两者p>0.001）。与无c-ACLD的患者相比，c-ACLD患者的SSM更高[65.2（四分位间距，33.8 - 75.0）对21.8（16.5 - 32.0）kPa；p<0.001]，脾脏体积更大[475（四分位间距，311 - 746）对154（112 - 283）cm³；p<0.001]。在所有多变量模型中，可检测HBV病毒载量（>10 UI/ml）、碱性磷酸酶（每IU/L）和GGT水平（每IU/L）与c-ACLD独立相关。脾脏体积[每cm³，比值比（OR） = 1.01（95%置信区间，1.01 - 1.02）；p = 0.002]、SSM[每kPa，OR = 1.04（1.01 - 1.07）；p = 0.012]和脾肿大[是与否，OR = 28.45（4.42 - 182.95）；p<0.001]与c-ACLD独立相关。
在亚马逊河流域西部的慢性HDV感染患者中，c-ACLD的患病率较高。HBV病毒载量、肝酶和脾脏特征可用于预测HDV感染患者的严重肝病。
