Huang X, Yao L, Deng Z R, Dong J, Zheng R J, Lu X B, Zhang Y X, Sun L H
Department of Infectious Disease, Infectious Disease Center of the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000, China.
Zhonghua Gan Zang Bing Za Zhi. 2021 Mar 20;29(3):227-233. doi: 10.3760/cma.j.cn501113-20200302-00081.
To analyze the clinical characteristics of HBV-related liver cirrhotic patients with low viral load. A retrospective analysis on 481 inpatients with HBV-related cirrhosis with low viral load [HBV DNA≤2 000 IU/ml (10(4) copies/ml)] general condition, virological indicators, liver function-related indicators, complications, and incidence of complications were analyzed. The t-test was used to compare the average measurement data, and the (2) test was used to compare the count data. 481 cases were mainly male (male/female: 324/157), aged 20-83 (53.31 ± 11.67) years old. Han nationality accounted for 71.518%. 386 cases were HBsAg positive. 391 cases were HBeAg positive, and 140 cases were HBV DNA positive. The average value of bilirubin, albumin, alanine aminotransferase, aspartate aminotransferase, platelets, and prothrombin were 50.59 ± 91.25 (μmol/L), 33.68 ± 7.5 (g/L), and 60.66 ± 106.95(U/L), 63.37 ± 86.19(U/L), 106.65 ± 83.22(×10(9)/L), 68.82% ± 25.33%, respectively. CTP class A/B/C had 220/150/111 cases. The average values of CTP, MELD, APRI and FIB-4 were 7.61 ± 2.58, 10.98 ± 5.79, 2.34 ± 3.56, 6.91 ± 8.04, respectively. The overall incidence of complications in HBV-related cirrhotic patients with low viral load, HBV DNA negative, HBV DNA positive, HBsAg negative, and HBsAg positive were 80.0%, 82.7%, 73.6%, 85.3%, and 78.8%, respectively. Among them, 283 cases (58.84%), 197 cases (55.77%), 86 cases (61.43%), 52 cases (54.74%) and 231 cases (59.84%) were of hypersplenism, and 267 cases (55.51%), 197 cases (55.77%), 70 cases (50.00%), 56 cases (58.95%), and 211 cases (54.66%) were of esophagogastric varices. There were 59 cases (12.27%), 48 cases (14.08%), 11 cases (7.86%), 12 cases (12.63%), and 47 cases (12.18%) of rupture of esophageal and gastric varices, respectively. 202 cases (42.00%), 147 cases (43.11%), 55 cases (39.29%), 42 cases (44.21%), and 160 cases (41.45%) were of ascites, respectively. 17 cases (3.53%), 12 cases (3.52%), 5 cases (3.5%), 2 cases (2.11%), 15 (3.89%) cases were of hepatic encephalopathy, respectively. There were 6 cases (1.25%), 3 cases (0.88%), 3 cases (2.14%), 0 cases (0%), 6 cases (1.55%) of liver cancer. 29 cases (6.03%), 21 cases (6.16%), 8 cases (5.71%), 9 cases (9.47%) and 20 cases (5.18%) were of portal vein thrombosis. Compared with the overall incidence of complications, 341 HBV DNA-negative patients and 95 HBsAg-negative patients still had higher incidence of complications. The patients were grouped by age, and in < 40 years old, 40-50 years old, and > 50 years old, the overall complications were 80.8% in 42 cases, 76.8% in 116 cases and 81.7% in 227 cases, and the difference was not statistically significant. HBV infection patients with low viral load, and those whose HBsAg has disappeared, are still at risk of developing liver cirrhosis and even serious complications, and whether such population need antiviral therapy and benefit from it deserves further research.
分析低病毒载量的HBV相关肝硬化患者的临床特征。对481例低病毒载量[HBV DNA≤2 000 IU/ml(10⁴拷贝/ml)]的HBV相关肝硬化住院患者的一般情况、病毒学指标、肝功能相关指标、并发症及并发症发生率进行回顾性分析。采用t检验比较计量资料的均值,采用χ²检验比较计数资料。481例患者以男性为主(男/女:324/157),年龄20 - 83(53.31±11.67)岁。汉族占71.518%。386例HBsAg阳性。391例HBeAg阳性,140例HBV DNA阳性。胆红素、白蛋白、谷丙转氨酶、谷草转氨酶、血小板及凝血酶原的均值分别为50.59±91.25(μmol/L)、33.68±7.5(g/L)、60.66±106.95(U/L)、63.37±86.19(U/L)、106.65±83.22(×10⁹/L)、68.82%±25.33%。CTP分级A/B/C分别有220/150/111例。CTP、MELD、APRI及FIB - 4的均值分别为7.61±2.58、10.98±5.79、2.34±3.56、6.91±8.04。低病毒载量的HBV相关肝硬化患者、HBV DNA阴性、HBV DNA阳性、HBsAg阴性及HBsAg阳性患者并发症的总发生率分别为80.0%、82.7%、73.6%、85.3%、78.8%。其中,脾功能亢进分别有283例(58.84%)、197例(55.77%)、86例(61.43%)、52例(54.74%)、231例(59.84%);食管胃静脉曲张分别有267例(55.51%)、197例(55.77%)、70例(50.00%)、56例(58.95%)、211例(54.66%)。食管胃静脉曲张破裂分别有59例(12.27%)、48例(14.08%)、11例(7.86%)、12例(12.63%)、47例(12.18%)。腹水分别有202例(42.00%)、147例(43.11%)、55例(39.29%)、42例(44.21%)、160例(41.45%)。肝性脑病分别有17例(3.53%)、12例(3.52%)、5例(3.5%)、2例(2.11%)、15例(3.89%)。肝癌分别有6例(1.25%)、3例(0.88%)、3例(2.14%)(0例(0%))、6例(1.55%)。门静脉血栓分别有29例(6.03%)、21例(6.16%)、8例(5.71%)、9例(9.47%)、20例(5.18%)。与并发症总发生率相比,341例HBV DNA阴性患者和95例HBsAg阴性患者并发症发生率仍较高。将患者按年龄分组,<40岁、40 - 50岁、>并症总发生率分别为42例中的80.8%、116例中的76.8%、227例中的81.7%,差异无统计学意义。低病毒载量的HBV感染患者以及HBsAg已消失的患者仍有发生肝硬化甚至严重并发症的风险,此类人群是否需要抗病毒治疗及其获益情况值得进一步研究。 50岁组,总体发