Fattovich G, Brollo L, Alberti A, Pontisso P, Giustina G, Realdi G
Istituto di Medicina Clinica, Università di Padova, Italy.
Hepatology. 1988 Nov-Dec;8(6):1651-4. doi: 10.1002/hep.1840080630.
Twenty-eight patients with chronic active hepatitis without cirrhosis who were positive for hepatitis B surface antigen and antibody to hepatitis B e antigen were followed for 1 to 15 years (mean 6.6 years) and underwent follow-up biopsy. At presentation, 12 of the 28 patients (43%) had hepatitis B virus DNA in serum, 10 (36%) had serologic evidence of hepatitis delta virus infection and 6 (21%) had no serologic markers of either hepatitis B virus replication or hepatitis delta virus infection. During follow-up, 15 (54%) patients developed active cirrhosis, including eight patients with hepatitis delta virus infection and five with hepatitis B virus DNA in serum. In seven (47%) of the 15 patients, cirrhosis developed within the first 2 years; all seven patients had bridging necrosis in the first liver biopsy, and five of these were infected with hepatitis delta virus. The remaining 13 (46%) patients did not develop cirrhosis during follow-up and showed either unchanged features of chronic active hepatitis (seven cases) or histologic improvement to chronic persistent hepatitis (five cases) or to normal liver (one case). In conclusion, the prognosis of anti-HBe-positive patients with chronic hepatitis B is poor, as 54% of the cases developed cirrhosis during a mean histologic follow-up period of 4.5 years, mainly in association with hepatitis delta virus infection or continuing hepatitis B virus replication.
对28例无肝硬化的慢性活动性乙型肝炎患者进行了随访，这些患者乙肝表面抗原和乙肝e抗原抗体均呈阳性，随访时间为1至15年（平均6.6年），并接受了随访活检。就诊时，28例患者中有12例（43%）血清中存在乙肝病毒DNA，10例（36%）有丁型肝炎病毒感染的血清学证据，6例（21%）既无乙肝病毒复制的血清学标志物，也无丁型肝炎病毒感染的血清学标志物。随访期间，15例（54%）患者发展为活动性肝硬化，其中8例为丁型肝炎病毒感染患者，5例血清中有乙肝病毒DNA。在这15例患者中的7例（47%）在最初2年内发展为肝硬化；所有7例患者在首次肝活检时均有桥接坏死，其中5例感染了丁型肝炎病毒。其余13例（46%）患者在随访期间未发展为肝硬化，表现为慢性活动性肝炎特征未改变（7例）或组织学改善为慢性持续性肝炎（5例）或正常肝脏（1例）。总之，抗-HBe阳性的慢性乙型肝炎患者预后较差，因为在平均4.5年的组织学随访期内，54%的病例发展为肝硬化，主要与丁型肝炎病毒感染或乙肝病毒持续复制有关。
