Chen Shanshan, Dai Xuan, Zhao Yueyue, Li Jie, Zou Xuehan, Huang Haijun
Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Zhejiang, Hangzhou 310014, China.
Center for General Practice Medicine, Department of Infectious Disease, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Zhejiang, Hangzhou 310014, China.
Gastroenterol Res Pract. 2023 Jul 11;2023:7264601. doi: 10.1155/2023/7264601. eCollection 2023.
In clinical practice, a considerable proportion of patients with chronic hepatitis B (CHB) who do not conform to any immune status are considered to be in the "indeterminate phase". In this study, we aim to study the clinical distribution characteristics and identification of significant liver inflammation in patients in indeterminate phase.
This study retrospectively analyze clinical data of 1226 patients with CHB at two medical centers in Zhejiang province. According to American Association for the Study of Liver Diseases (AASLD) 2018 hepatitis B guidance, CHB can be divided into four phases: immune-tolerant phase, HBeAg-positive immune active phase, inactive phase, and HBeAg-negative immune active phase. Liver inflammation grade was evaluated using the Scheuer scoring system, and significant liver inflammation was defined as ≥ 2.
The distribution of different immune status was as follows: 259 (21.1%) patients in immune-tolerant phase, 365 (29.8%) patients in HBeAg-positive immune active phase, 128 (10.4%) patients in inactive phase, and 33 (2.7%) patients in HBeAg-negative immune active phase. However, 441 (36.0%) patients did not meet any of the above immune phases, which were defined as indeterminate phase. Significant liver inflammation (54.1%) was common in CHB patients with indeterminate phase. Prothrombin time (PT), platelet count (PLT), alanine aminotransferase (ALT), and hepatitis B virus (HBV)-DNA were associated with significant inflammation.
The results of this study showed that about 36.0% of patients were divided into indeterminate phase. The proportion of patients with significant inflammation in indeterminate phase and liver inflammation becomes more severe with aggravation of fibrosis stage. PT, PLT, ALT, and HBV-DNA may have a significant correlation with severe inflammation and prognosis of CHB.
在临床实践中，相当一部分不符合任何免疫状态的慢性乙型肝炎（CHB）患者被认为处于“不确定期”。在本研究中，我们旨在研究不确定期患者的临床分布特征及显著肝脏炎症的识别。
本研究回顾性分析了浙江省两个医疗中心1226例CHB患者的临床资料。根据美国肝病研究协会（AASLD）2018年乙型肝炎指南，CHB可分为四个阶段：免疫耐受期、HBeAg阳性免疫活跃期、非活动期和HBeAg阴性免疫活跃期。采用Scheuer评分系统评估肝脏炎症分级，显著肝脏炎症定义为≥2级。
不同免疫状态的分布如下：免疫耐受期患者259例（21.1%），HBeAg阳性免疫活跃期患者365例（29.8%），非活动期患者128例（10.4%），HBeAg阴性免疫活跃期患者33例（2.7%）。然而，441例（36.0%）患者不符合上述任何免疫阶段，被定义为不确定期。不确定期CHB患者中显著肝脏炎症（54.1%）较为常见。凝血酶原时间（PT）、血小板计数（PLT）、丙氨酸氨基转移酶（ALT）和乙型肝炎病毒（HBV）DNA与显著炎症相关。
本研究结果显示，约36.0%的患者被分为不确定期。不确定期患者中显著炎症的比例以及肝脏炎症随纤维化阶段加重而更严重。PT、PLT、ALT和HBV-DNA可能与CHB的严重炎症和预后有显著相关性。
