低病毒载量乙型肝炎患者中 HBV DNA 水平波动与肝纤维化程度较低相关。

Lower prevalence of hepatic fibrosis in low viremic hepatitis B patients with fluctuating HBV DNA levels.

机构信息

Department of Medicine, Gastroenterology Unit, King Abdulaziz Medical City, Jeddah, Saudi Arabia.

College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah; Department of Hepatobiliary Sciences and Organ Transplant Center, Division of Hepatology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

出版信息

Saudi J Gastroenterol. 2022 Sep-Oct;28(5):341-347. doi: 10.4103/sjg.sjg_48_22.

DOI:10.4103/sjg.sjg_48_22

PMID:35488588

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9752532/

Abstract

BACKGROUND

In chronic hepatitis B virus (HBV) patients, fluctuations in HBV DNA serve as a "gray area" and impede the accurate identification of inactive carriers. We aimed to assess if such fluctuations impact the presence of significant hepatic fibrosis (Metavir F2-4) in chronic HBV patients.

METHODS

Consecutive, untreated HBeAg-negative carriers (n = 234) with fluctuating HBV DNA (n = 73) above or below a level of 2000 IU/mL were included and compared to those without fluctuations (n = 161). Patients without fluctuating HBV DNA were further analyzed based on those with persistently low (<2,000 IU/mL, n = 137) and higher HBV DNA (2,000-20,000 IU/mL, n = 24). Hepatic fibrosis (assessed by transient elastography) was correlated with virologic and biochemical profiles.

RESULTS

The mean age of the overall cohort was 47.8 ± 11.1 years, of whom 107 (45.7%) were male. During a median of 60 months (interquartile range [IQR] 34-82) of follow-up, 73 (31.2%) patients had a mean of 1.6 ± 0.9 fluctuations in HBV DNA. The median time to the first fluctuation was at 14.5 (IQR 5.0-33.7) months. Patients with fluctuating viremia had higher log qHBsAg (3.1 ± 0.8 vs. 2.7 ± 1.0, P = 0.022) and HBV DNA (3.4 ± 0.5 vs. 2.7 ± 0.8, P < 0.001) compared to those without fluctuations. Patients with fluctuant viremia were less likely to have F2-4 fibrosis (8.2%) compared to those without fluctuant viremia (18.2%, odds ratio [OR]: 0.407, 95% confidence interval [CI]: 0.161-1.030; P = 0.052). Males tended to have less fluctuation constituting 37.0% of patients with fluctuating HBV DNA (P = 0.071). Fluctuations occurred more frequently in those with predominantly higher HBV DNA levels (26.0%) compared to those without fluctuations (14.9%; P = 0.030).

CONCLUSIONS

Fluctuating HBV DNA levels occur frequently but are not associated with significant fibrosis. Minor fluctuations in HBV DNA levels are unlikely to be of clinical relevance.

摘要

背景

在慢性乙型肝炎病毒（HBV）患者中，HBV DNA 的波动是一个“灰色地带”，阻碍了对非活动携带者的准确识别。我们旨在评估这种波动是否会影响慢性 HBV 患者是否存在显著的肝纤维化（Metavir F2-4）。

方法

连续纳入了 234 名未经治疗的 HBeAg 阴性携带者（n=234），其中 73 名（n=73）HBV DNA 波动高于或低于 2000 IU/mL，并与无波动的患者（n=161）进行比较。无波动 HBV DNA 的患者进一步根据 HBV DNA 持续低水平（<2000 IU/mL，n=137）和高水平（2000-20000 IU/mL，n=24）进行分析。通过瞬时弹性成像评估肝纤维化与病毒学和生化特征的相关性。

结果

总体队列的平均年龄为 47.8±11.1 岁，其中 107 名（45.7%）为男性。在中位数为 60 个月（四分位距 [IQR] 34-82）的随访期间，73 名（31.2%）患者的 HBV DNA 平均波动 1.6±0.9 次。首次波动的中位时间为 14.5（IQR 5.0-33.7）个月。病毒血症波动的患者的 log qHBsAg（3.1±0.8 比 2.7±1.0，P=0.022）和 HBV DNA（3.4±0.5 比 2.7±0.8，P<0.001）均高于无波动的患者。病毒血症波动的患者发生 F2-4 纤维化的可能性低于无病毒血症波动的患者（8.2%比 18.2%，比值比 [OR]：0.407，95%置信区间 [CI]：0.161-1.030；P=0.052）。男性更倾向于发生病毒血症波动，占病毒血症波动患者的 37.0%（P=0.071）。波动更频繁地发生在 HBV DNA 水平较高的患者中（26.0%），而不是无波动的患者（14.9%；P=0.030）。