Furquim d'Almeida Arno, Ho Erwin, Govaerts Liesbeth, Michielsen Peter, Sersté Thomas, Bourgeois Stefan, Delwaide Jean, Moreno Christophe, Orlent Hans, Van Vlierberghe Hans, de Galocsy Chantal, Peeters Michael, Padalko Elizaveta, Van Gucht Steven, Vanwolleghem Thomas
Viral Hepatitis Research Group, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.
Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium.
J Viral Hepat. 2025 Feb;32(2):1-15. doi: 10.1111/jvh.14060.
Hepatitis B virus (HBV)-hepatitis delta virus (HDV) coinfection is the most severe form of chronic viral hepatitis, but the factors that determine disease progression and severity are incompletely characterised. This long-term follow-up study aims to identify risk factors for severe liver-related outcomes. In this multicentre national cohort study, data from admission until the last visit between 2001 and 2023 was retrospectively collected from 162 HBV-HDV coinfected patients. The inclusion criteria were HBsAg or HBV DNA positivity, anti-HDV or HDV RNA positivity, and at least one follow-up visit. The median follow-up was 6.2 years (IQR 3.3-10.2). At baseline, 68/152 (44.7%) patients were diagnosed with advanced liver fibrosis. Forty patients (24.7%) had at least one severe liver-related outcome during follow-up. HDV viremia was detectable in 92 patients (64.3%) at last evaluation and was more frequently detectable in patients of European origin (p < 0.001). HDV RNA-positive patients had a 4.7-fold higher risk for severe liver-related outcomes (p < 0.001) and were more frequently diagnosed with advanced fibrosis at baseline (p = 0.007) compared to HDV RNA-negative patients. Multivariate analyses identified HDV RNA positivity, as well as several markers for liver disease severity, such as INR, platelet count, and advanced fibrosis at baseline, and age at admission as independent risk factors for severe liver-related outcomes. In conclusion, almost one in four HBV-HDV coinfected patients developed a severe liver-related outcome during follow-up. Several markers for liver disease severity and HDV RNA positivity were the strongest predictors for outcomes.
乙型肝炎病毒（HBV）-丁型肝炎病毒（HDV）合并感染是慢性病毒性肝炎最严重的形式，但决定疾病进展和严重程度的因素尚未完全明确。这项长期随访研究旨在确定严重肝脏相关结局的危险因素。在这项多中心全国队列研究中，回顾性收集了2001年至2023年间162例HBV-HDV合并感染患者从入院到最后一次随访的数据。纳入标准为HBsAg或HBV DNA阳性、抗HDV或HDV RNA阳性，以及至少一次随访。中位随访时间为6.2年（四分位间距3.3 - 10.2年）。基线时，152例患者中有68例（44.7%）被诊断为晚期肝纤维化。40例患者（24.7%）在随访期间至少出现一次严重肝脏相关结局。在最后一次评估时，92例患者（64.3%）可检测到HDV病毒血症，且在欧洲血统患者中更常检测到（p < 0.001）。与HDV RNA阴性患者相比，HDV RNA阳性患者出现严重肝脏相关结局的风险高4.7倍（p < 0.001），且在基线时更常被诊断为晚期纤维化（p = 0.007）。多变量分析确定HDV RNA阳性，以及一些肝脏疾病严重程度的标志物，如国际标准化比值（INR）、血小板计数、基线时的晚期纤维化，以及入院时的年龄是严重肝脏相关结局的独立危险因素。总之，近四分之一的HBV-HDV合并感染患者在随访期间出现了严重肝脏相关结局。几种肝脏疾病严重程度的标志物和HDV RNA阳性是结局的最强预测因素。
