Huang De-Liang, Cai Qin-Xian, Zhou Guang-De, Yu Hong, Zhu Zhi-Bin, Peng Jing-Han, Chen Jun
Department of Liver Diseases, The Third People's Hospital of Shenzhen, Shenzhen 510000, Guangdong Province, China.
Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing 100000, China.
World J Hepatol. 2024 Jun 27;16(6):920-931. doi: 10.4254/wjh.v16.i6.920.
Studies with large size samples on the liver histological changes of indeterminate phase chronic hepatitis B (CHB) patients were not previously conducted.
To assess the liver histological changes in the indeterminate phase CHB patients using liver biopsy.
The clinical and laboratory data of 1532 untreated CHB patients were collected, and all patients had least once liver biopsy from January 2015 to December 2021. The significant differences among different phases of CHB infection were compared with -test, and the risk factors of significant liver histological changes were analyzed by the multivariate logistic regression analysis.
Among 1532 untreated CHB patients, 814 (53.13%) patients were in the indeterminate phase. Significant liver histological changes (defined as biopsy score ≥ G2 and/or ≥ S2) were found in 488/814 (59.95%) CHB patients in the indeterminate phase. Significant liver histological changes were significant differences among different age, platelets (PLTs), and alanine aminotransferase (ALT) subgroup in indeterminate patient. Multivariate logistic regression analysis indicated that age ≥ 40 years old [adjust odd risk (aOR), 1.44; 95% confidence interval (CI): 1.06-1.97; = 0.02], PLTs ≤ 150 × 10/L (aOR, 2.99; 95%CI: 1.85-4.83; < 0.0001), and ALT ≥ upper limits of normal (aOR, 1.48; 95%CI: 1.08, 2.05, = 0.0163) were independent risk factors for significant liver histological changes in CHB patients in the indeterminate phase.
Our results suggested that significant liver histological changes were not rare among the untreated CHB patients in indeterminate phase, and additional strategies are urgently required for the management of these patients.
此前尚未对大量不确定期慢性乙型肝炎（CHB）患者的肝脏组织学变化进行研究。
通过肝活检评估不确定期CHB患者的肝脏组织学变化。
收集1532例未经治疗的CHB患者的临床和实验室数据，所有患者在2015年1月至2021年12月期间至少接受过一次肝活检。采用t检验比较CHB感染不同阶段的显著差异，并通过多因素logistic回归分析分析肝脏组织学显著变化的危险因素。
在1532例未经治疗的CHB患者中，814例（53.13%）处于不确定期。在不确定期的814例CHB患者中，488例（59.95%）出现肝脏组织学显著变化（定义为活检评分≥G2和/或≥S2）。不确定期患者不同年龄、血小板（PLT）和丙氨酸氨基转移酶（ALT）亚组之间肝脏组织学显著变化存在显著差异。多因素logistic回归分析表明，年龄≥40岁[调整后的优势比（aOR），1.44；95%置信区间（CI）：1.06 - 1.97；P = 0.02]、PLT≤150×10⁹/L（aOR，2.99；95%CI：1.85 - 4.83；P < 0.0001）和ALT≥正常上限（aOR，1.48；95%CI：1.08，2.05，P = 0.0163）是不确定期CHB患者肝脏组织学显著变化的独立危险因素。
我们的结果表明，在未经治疗的不确定期CHB患者中，肝脏组织学显著变化并不罕见，迫切需要针对这些患者采取额外的管理策略。
