Cunha-Silva Marlone, Marinho Fábio R T, Oliveira Paulo F, Lopes Tirzah M, Sevá-Pereira Tiago, Lorena Sonia L S, Almeida Jazon R S
Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Gastroenterologia, Campinas, SP, Brazil.
Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Gastroenterologia, Campinas, SP, Brazil.
Braz J Infect Dis. 2017 Jul-Aug;21(4):441-447. doi: 10.1016/j.bjid.2017.03.019. Epub 2017 May 26.
Chronic hepatitis B is a major cause of cirrhosis, and the natural history of the disease has several clinical stages that should be thoroughly understood for the implementation of proper treatment. Nonetheless, curing the disease with antiviral treatment remains a challenge.
To describe the clinical course, response to treatment, and poor prognostic factors in 247 hepatitis B virus chronic infection patients treated in a tertiary hospital in Brazil.
This was a retrospective and observational study, by analyzing the medical records of HBV infected patients between January 2000 and January 2015.
Most patients were male (67.2%) and 74.1% were HBeAg negative. Approximately 41% had cirrhosis and 8.5% were hepatitis C virus coinfected. The viral load was negative after two years on lamivudine, entecavir and tenofovir in 86%, 90.6%, and 92.9% of the patients, respectively. The five-year resistance rates for lamivudine, adefovir, entecavir, and tenofovir were 57.5%, 51.8%, 1.9%, and 0%, respectively. The overall seroconversion rates were 31.2% for HBeAg and 9.4% for HBsAg. Hepatocellular carcinoma was diagnosed in 9.7% of patients, liver transplantation was performed in 9.7%, and overall mortality was 10.5%. Elevations of serum alanine aminotransferase (p=0.0059) and viral load (p<0.0001) were associated with progression to liver cirrhosis. High viral load was associated with progression to hepatocellular carcinoma (p<0.0001). Significant risk factors associated with death were elevated alanine aminotransferase (p=0.0039), liver cirrhosis (p<0.0001), high viral load (p=0.007), and hepatocellular carcinoma (p=0.0008). HBeAg positive status was not associated with worse outcomes, and treatment may have been largely responsible.
Elevations of viral load and serum alanine aminotransferase may select patients with worse prognosis, especially progression to cirrhosis and hepatocellular carcinoma, which were strongly association with death.
慢性乙型肝炎是肝硬化的主要病因，该疾病的自然史有几个临床阶段，为实施恰当治疗，应全面了解这些阶段。尽管如此，通过抗病毒治疗治愈该疾病仍然是一项挑战。
描述在巴西一家三级医院接受治疗的247例乙型肝炎病毒慢性感染患者的临床病程、治疗反应及不良预后因素。
这是一项回顾性观察研究，通过分析2000年1月至2015年1月期间HBV感染患者的病历进行研究。
大多数患者为男性（67.2%），74.1%的患者HBeAg阴性。约41%的患者有肝硬化，8.5%的患者合并丙型肝炎病毒感染。分别有86%、90.6%和92.9%的患者在使用拉米夫定、恩替卡韦和替诺福韦治疗两年后病毒载量呈阴性。拉米夫定、阿德福韦、恩替卡韦和替诺福韦的五年耐药率分别为57.5%、51.8%、1.9%和0%。HBeAg的总体血清学转换率为31.2%，HBsAg的总体血清学转换率为9.4%。9.7%的患者被诊断为肝细胞癌，9.7%的患者接受了肝移植，总体死亡率为10.5%。血清丙氨酸氨基转移酶升高（p=0.0059）和病毒载量升高（p<0.0001）与进展为肝硬化相关。高病毒载量与进展为肝细胞癌相关（p<0.0001）。与死亡相关的显著危险因素包括丙氨酸氨基转移酶升高（p=0.0039）、肝硬化（p<0.0001）、高病毒载量（p=0.007）和肝细胞癌（p=0.0008）。HBeAg阳性状态与较差的预后无关，这可能很大程度上归因于治疗。
病毒载量和血清丙氨酸氨基转移酶升高可能提示患者预后较差，尤其是进展为肝硬化和肝细胞癌，这与死亡密切相关。
