Huang Yi-Jie, Wang Jun-Sing, Chen Cheng-Hsu, Lee Shou-Wu, Chang Chung-Hsin, Liao Szu-Chia, Peng Yen-Chun, Lee Teng-Yu, Li Tsai-Chung
Department of Public Health, College of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung, 406040, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Sci Rep. 2025 Jan 2;15(1):562. doi: 10.1038/s41598-024-84413-0.
The role of pre-treatment HBV DNA levels on the prognosis of hepatitis B virus-related decompensated cirrhosis is unclear. This study investigated the effects of pre-treatment HBV DNA and other determinants on short-term and long-term survival of chronic hepatitis B (CHB) patients with decompensated cirrhosis. A total of 278 cirrhotic decompensated CHB patients treated with entecavir or tenofovir disoproxil fumarate were retrospectively enrolled. Cox regression models were used to analyze factors associated with all-cause mortality. The median follow-up time was 17 months (IQR2.17-58.94), during which 132 patients (47.4%) either died or underwent liver transplantation. The cumulative incidence of all-cause mortality was 16%, 29%, 34%, 39%, and 51% at the 1-month, 3-month, 6-month, 1-year, and 5-year follow-ups, respectively. Risk factors associated with 3-month all-cause mortality were age, presence of ascites and hepatic encephalopathy, baseline hepatitis flares, pre-treatment HBV DNA levels, and MELD scores. In the subgroup analysis, for 3-month all-cause mortality, significant associations of age, baseline hepatitis flares, and MELD scores with pre-treatment HBV DNA levels were observed (p for interaction were 0.005, 0.032, and 0.030, respectively). Risk factors associated with 5-year all-cause mortality were age, the presence of ascites and hepatic encephalopathy, and MELD scores. Liver functional reserve and age played a critical role in the prognosis of CHB patients with decompensated cirrhosis. Pre-treatment HBV DNA levels had an impact on short-term all-cause mortality, but not on long-term all-cause mortality.
治疗前乙肝病毒脱氧核糖核酸（HBV DNA）水平对乙型肝炎病毒相关失代偿期肝硬化预后的作用尚不清楚。本研究调查了治疗前HBV DNA及其他决定因素对失代偿期肝硬化慢性乙型肝炎（CHB）患者短期和长期生存的影响。共回顾性纳入了278例接受恩替卡韦或富马酸替诺福韦二吡呋酯治疗的失代偿期CHB肝硬化患者。采用Cox回归模型分析与全因死亡率相关的因素。中位随访时间为17个月（四分位间距2.17 - 58.94），在此期间132例患者（47.4%）死亡或接受了肝移植。在1个月、3个月、6个月、1年和5年随访时，全因死亡率的累积发生率分别为16%、29%、34%、39%和51%。与3个月全因死亡率相关的危险因素为年龄、腹水和肝性脑病的存在、基线肝炎发作、治疗前HBV DNA水平和终末期肝病模型（MELD）评分。在亚组分析中，对于3个月全因死亡率，观察到年龄、基线肝炎发作和MELD评分与治疗前HBV DNA水平存在显著关联（交互作用的p值分别为0.005、0.032和0.030）。与5年全因死亡率相关的危险因素为年龄、腹水和肝性脑病的存在以及MELD评分。肝功能储备和年龄在失代偿期肝硬化CHB患者的预后中起关键作用。治疗前HBV DNA水平对短期全因死亡率有影响，但对长期全因死亡率无影响。
