Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Clin Gastroenterol Hepatol. 2023 Jun;21(6):1503-1512.e4. doi: 10.1016/j.cgh.2022.06.015. Epub 2022 Jul 16.
BACKGROUND & AIMS: Most patients in the immunotolerant (IT) phase of chronic hepatitis B (CHB) transition to the immune active (IA-hepatitis B surface antigen [HBeAg]+) phase by early adulthood. We examined characteristics of adults in the IT vs IA-HBeAg+ phase and rate of transition from IT to other phases of CHB, with a focus on those ≥40 years.
Demographic, clinical, and virologic characteristics of participants in the Hepatitis B Research Network adult cohort study with IT CHB (alanine aminotransferase ≤1.5 × upper limit of normal, hepatitis B virus DNA >10 IU/mL) were compared by age category, and to those with IA-HBeAg+ CHB in cross-sectional analysis. This study received institutional review board approval at all participating centers.
Of 107 adult IT participants, 52 (48%) were <30, 33 (31%) were 30 to 39, and 22 (21%) were ≥40 years old (maximum, 71 years). Among IT groups, the proportion born in Asia and duration of CHB were greater in older IT groups, but virologic and liver disease characteristics were similar. Compared with IA-HBeAg+ participants (n = 192), IT participants were younger, fewer were men, more were Asian, and platelets, qHBsAg, and qHBeAg levels were higher. Similar differences were observed when comparisons were made with the ≥40 years IT group. Among IT participants, 60 (56%) transitioned during 206 person-years of follow-up. The phase transition rate per 100 person-years was highest in the <30 years group (33.0 [95% confidence interval [CI], 23.4-46.7]) vs the 30 to 39 years group (24.8 [95% CI, 15.6-39.4]) and ≥40 group (27.4 [95% CI, 14.8-50.9]), but 95% CIs overlapped.
In a large North American population, over 50% of adults in the IT phase of CHB were ≥30 years and 20% were ≥40 years old, but older IT patients had similar characteristics and rates of transition as younger IT patients.
大多数慢性乙型肝炎（CHB）免疫耐受（IT）阶段的患者在成年早期会过渡到免疫激活（IA-HBeAg+）阶段。我们研究了 IT 期和 IA-HBeAg+期成人的特征以及从 IT 期向 CHB 其他阶段过渡的速度，重点关注年龄≥40 岁的患者。
对乙型肝炎研究网络成人队列研究中 IT CHB（丙氨酸氨基转移酶≤1.5×正常值上限，乙型肝炎病毒 DNA>10IU/mL）患者的人口统计学、临床和病毒学特征按年龄分类进行比较，并与 IA-HBeAg+CHB 患者进行横断面分析。所有参与中心的机构审查委员会均批准了本研究。
在 107 名 IT 期成人参与者中，52 名（48%）年龄<30 岁，33 名（31%）年龄为 30 至 39 岁，22 名（21%）年龄≥40 岁（最大年龄 71 岁）。在 IT 组中，年龄较大的 IT 组中亚洲出生比例和 CHB 持续时间较大，但病毒学和肝病特征相似。与 IA-HBeAg+参与者（n=192）相比，IT 参与者年龄较小，男性较少，亚洲人较多，血小板、qHBsAg 和 qHBeAg 水平较高。当与≥40 岁的 IT 组进行比较时，也观察到了类似的差异。在 IT 参与者中，在 206 人年的随访期间，有 60 人（56%）发生了阶段转换。每 100 人年的阶段转换率在<30 岁组最高（33.0[95%置信区间（CI），23.4-46.7]），在 30 至 39 岁组（24.8[95%CI，15.6-39.4]）和≥40 岁组（27.4[95%CI，14.8-50.9]）也较高，但 95%CI 重叠。
在一个大型的北美人群中，超过 50%的 CHB IT 期患者年龄≥30 岁，20%的患者年龄≥40 岁，但年龄较大的 IT 患者与年龄较小的 IT 患者具有相似的特征和过渡率。
