Zhou L L, Bai X X, Dong B, Xin J J, Xu G H, Liu N
Department of Infectious Diseases, Affiliated Hospital of Yan'an University, Key Laboratory of Yan'an, Yan'an716000, China.
Department of Infectious Diseases, the First Hospital of Yulin, Yulin719000, China.
Zhonghua Gan Zang Bing Za Zhi. 2024 Nov 20;32(11):970-975. doi: 10.3760/cma.j.cn501113-20231028-00158.
To analyze the clinical characteristics of HBeAg-negative chronic hepatitis B virus (HBV) infection in indeterminate phase with a low viral load. One hundred and thirty-nine cases with persistent normal alanine aminotransferase (ALT) and HBeAg-negative chronic HBV infection with low viral load who visited the Department of Infectious Diseases of the Affiliated Hospital of Yan'an University from September 2013 to July 2021 were retrospectively collected. Patients were divided into low hepatitis B surface antigen (HBsAg) group (=59) and high HBsAg group (=80) according to the baseline hepatitis B surface antigen (HBsAg) level. The changes of various indicators at baseline and follow-up endpoints were analyzed between the two groups. The rate of HBsAg decrease ≥0.5 logIU/ml, HBV DNA negative conversion rate, ALT persistently normal rate, and liver stiffness measurement (LSM) persistently normal rate at the end of the follow-up were compared. The -test, or non-parametric Mann-Whitney test, and Wilcoxon signed rank test were used for comparison of continuous data between the two groups. The test, or Fisher's exact probability method, was used for comparing count data between the two groups. There were statistically significant differences in age, gender, and HBsAg at baseline, but there was no statistically significant difference in terms of family history of hepatitis B, follow-up time, anti-HBe, anti-HBc, HBV DNA, ALT, aspartate aminotransferase (AST), albumin (Alb), and LSM between the two groups. There were statistically significant differences in HBsAg, anti-HBc, and ALT levels before and after follow-up in the low HBsAg group, but no statistically significant differences in anti-HBe, HBV DNA, AST, Alb, and LSM levels. There were statistically significant differences in HBsAg and anti-HBc before and after follow-up in the high HBsAg group, but no statistically significant differences in anti-HBe, HBV DNA, ALT, AST, Alb, and LSM. A liver biopsy was performed in 66 patients during follow-up, and 27.27% of the patients had moderate liver damage. In the low HBsAg group, 45.76% of patients had a HBsAg decrease rate of ≥0.5 logIU/ml, 10.17% of patients had HBV DNA negative conversion, 88.14% of patients had a persistently normal ALT, and 96.61% of patients had a persistently normal LSM at the end of follow-up. In the high HBsAg group, 3.75% of patients had a HBsAg decrease of ≥0.5 logIU/ml, no patient had a HBV DNA negative conversion, 90% of patients had a persistently normal ALT, and 98.75% of patients had a persistently normal LSM. There were statistically significant differences in the HBsAg decrease rate (45.76% vs. 3.75%, =32.975, ＜0.001) and HBV DNA negative conversion rate (10.17% vs. 0, =6.219, =0.013) between the two groups at the end of follow-up, but there were no statistically significant differences in the persistently normal ALT and LSM rates. The vast majority of patients with HBeAg-negative chronic HBV infection in the indeterminate phase with low viral load had persistent hypoviremia over the long term. Some patients have liver tissue damage and may progress to cirrhosis and liver cancer as a result of HBV DNA positivity, so antiviral treatment should be initiated in all.
分析病毒载量低的不确定期HBeAg阴性慢性乙型肝炎病毒（HBV）感染的临床特征。回顾性收集2013年9月至2021年7月在延安大学附属医院感染科就诊的139例丙氨酸氨基转移酶（ALT）持续正常且病毒载量低的HBeAg阴性慢性HBV感染患者。根据基线乙型肝炎表面抗原（HBsAg）水平将患者分为低HBsAg组（n = 59）和高HBsAg组（n = 80）。分析两组在基线和随访终点时各项指标的变化。比较随访结束时HBsAg下降≥0.5 logIU/ml的发生率、HBV DNA阴转率、ALT持续正常率和肝脏硬度值（LSM）持续正常率。两组间连续数据的比较采用t检验或非参数Mann-Whitney检验以及Wilcoxon符号秩检验。两组间计数数据的比较采用χ²检验或Fisher确切概率法。两组在年龄、性别和基线HBsAg方面存在统计学显著差异，但在乙肝家族史、随访时间、抗-HBe、抗-HBc、HBV DNA、ALT、天冬氨酸氨基转移酶（AST）、白蛋白（Alb）和LSM方面无统计学显著差异。低HBsAg组随访前后HBsAg、抗-HBc和ALT水平存在统计学显著差异，但抗-HBe、HBV DNA、AST、Alb和LSM水平无统计学显著差异。高HBsAg组随访前后HBsAg和抗-HBc存在统计学显著差异，但抗-HBe、HBV DNA、ALT、AST、Alb和LSM无统计学显著差异。随访期间对66例患者进行了肝活检，27.27%的患者有中度肝损伤。随访结束时，低HBsAg组45.76%的患者HBsAg下降率≥0.5 logIU/ml，10.17%的患者HBV DNA阴转，88.14%的患者ALT持续正常，96.61%的患者LSM持续正常。高HBsAg组3.75%的患者HBsAg下降≥0.5 logIU/ml，无患者HBV DNA阴转，90%的患者ALT持续正常，98.75%的患者LSM持续正常。随访结束时两组间HBsAg下降率（45.76%对3.75%，z = 32.975，P＜0.001）和HBV DNA阴转率（10.17%对0，z = 6.219，P = 0.013）存在统计学显著差异，但ALT持续正常率和LSM持续正常率无统计学显著差异。绝大多数病毒载量低的不确定期HBeAg阴性慢性HBV感染患者长期存在持续性低病毒血症。部分患者有肝组织损伤，可能因HBV DNA阳性而进展为肝硬化和肝癌，因此均应启动抗病毒治疗。
