Department of Infectious Diseases, Institute of Hepatology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China.
World J Gastroenterol. 2023 Aug 28;29(32):4900-4911. doi: 10.3748/wjg.v29.i32.4900.
Wilson disease (WD) is the most common genetic metabolic liver disease. Some studies have shown that comorbidities may have important effects on WD. Data on hepatitis B virus (HBV) infection in patients with WD are limited.
To investigate the prevalence and clinical impact of HBV infection in patients with WD.
The clinical data of patients with WD were analyzed retrospectively, and the data of patients with concurrent WD and HBV infection were compared with those of patients with isolated WD.
Among a total of 915 WD patients recruited, the total prevalence of current and previous HBV infection was 2.1% [95% confidence interval (CI): 1.2%-3.0%] and 9.2% (95%CI: 7.3%-11.1%), respectively. The main finding of this study was the identification of 19 patients with concurrent WD and chronic hepatitis B (CHB) infection. The diagnosis of WD was missed in all but two patients with CHB infection. The mean delay in the diagnosis of WD in patients with concurrent WD and CHB infection was 32.5 mo, which was significantly longer than that in patients with isolated WD (10.5 mo). The rates of severe liver disease and mortality in patients with concurrent WD and CHB infection were significantly higher than those in patients with isolated WD (63.1% 19.3%, = 0.000 and 36.8% 4.1%, < 0.001, respectively). Binary logistic regression analysis revealed a significantly higher risk of severe liver disease at the diagnosis of WD in patients with current HBV infection [odds ratio (OR) = 7.748; 95%CI: 2.890-20.774; = 0.000)] or previous HBV infection (OR = 5.525; 95%CI: 3.159-8.739; = 0.000) than in patients with isolated WD.
The total prevalence of current HBV infection in patients with WD was 2.1%. The diagnosis of WD in CHB patients is usually missed. HBV infection is an independent risk factor for severe liver disease in WD patients. The diagnosis of WD should be ruled out in some patients with CHB infection.
威尔逊病（WD）是最常见的遗传性代谢性肝病。一些研究表明，合并症可能对 WD 有重要影响。关于 WD 患者乙型肝炎病毒（HBV）感染的数据有限。
探讨 WD 患者 HBV 感染的流行情况及其对 WD 的临床影响。
回顾性分析 WD 患者的临床资料，并比较合并 WD 和 HBV 感染患者与单纯 WD 患者的资料。
共纳入 915 例 WD 患者，HBV 现症和既往感染的总患病率分别为 2.1%（95%可信区间：1.2%-3.0%）和 9.2%（95%可信区间：7.3%-11.1%）。本研究的主要发现是鉴定出 19 例合并 WD 和慢性乙型肝炎（CHB）感染的患者。在所有合并 CHB 感染的患者中，除 2 例外，均漏诊了 WD 的诊断。合并 WD 和 CHB 感染的患者诊断为 WD 的平均延迟时间为 32.5 个月，明显长于单纯 WD 患者（10.5 个月）。合并 WD 和 CHB 感染患者严重肝病和死亡率显著高于单纯 WD 患者（63.1%比 19.3%，=0.000 和 36.8%比 4.1%，均<0.001）。二元逻辑回归分析显示，HBV 现症感染（比值比[OR] = 7.748；95%可信区间：2.890-20.774；=0.000）或既往感染（OR = 5.525；95%可信区间：3.159-8.739；=0.000）的 WD 患者发生严重肝病的风险显著高于单纯 WD 患者。
WD 患者 HBV 现症感染的总患病率为 2.1%。CHB 患者的 WD 诊断通常被漏诊。HBV 感染是 WD 患者发生严重肝病的独立危险因素。对于某些 CHB 感染患者，应排除 WD 诊断。
