接受核苷（酸）类似物治疗的慢性乙型肝炎患者合并奥密克戎BA.5感染：中国南方的一项回顾性研究
Patients with chronic hepatitis B under nucleos(t)ide analog therapy with Omicron BA.5 infection: A retrospective study in South China.
作者信息
Wang Peipei, Chen Junjian, Chen Dabiao, Lei Ziying, Mo Zhishuo, Zhang Ying
机构信息
Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Guangdong Provincial Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
出版信息
Liver Res. 2024 Nov 20;9(1):66-73. doi: 10.1016/j.livres.2024.11.003. eCollection 2025 Mar.
BACKGROUND AND AIMS
Clinical data regarding patients with chronic hepatitis B (CHB) after Omicron BA.5 infection are currently limited. This study aimed to assess the clinical characteristics of patients with CHB and Omicron BA.5 infection in South China.
METHODS
This retrospective study was conducted from January to March 2023 in a cohort of 485 healthy individuals and 553 patients with CHB. Clinical features, encompassing COVID-19-related symptoms, levels of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies, vaccination status, liver functions, and virological markers of hepatitis B virus (HBV) infection were measured.
RESULTS
COVID-19-related symptom patterns were similar in both groups, except for fever, which was notably less prevalent (85.4% 90.4%, = 0.047) among patients with CHB who experienced a significantly shorter duration of fever (median 2.2 (25th-75th percentile, 1.0-3.0) days 2.3 (1.0-3.0) days, = 0.048) and a shorter time for symptom relief (9.2 (5.0-14.0) 11.1 (5.0-14.0) days, = 0.015). The levels of SARS-CoV-2 antibodies were comparable between the two groups but increased after booster vaccinations. In patients with CHB, globulin (GLB) and hepatitis B envelope antibody levels were significantly increased after Omicron BA.5 infection, regardless of nucleos(t)ide analog regimens comparing entecavir (ETV) with tenofovir (TFV). Patients with CHB treated with TFV had significantly higher levels of SARS-CoV-2 antibodies than those treated with ETV (1065.1 (346.9-1188.5) COI 765.5 (24.5-1119.1) COI, = 0.025).
CONCLUSIONS
No significant exacerbation of COVID-19 symptoms was observed in conjunction with the efficacy of COVID-19 booster vaccinations. There were no notable alterations in liver functions except for GLB. HBV reactivation, as evidenced by increased HBV DNA, was observed among patients with CHB after Omicron BA.5 infection. These changes were not affected by ETV versus TFV administration; however, TFV resulted in a significant increase in SARS-CoV-2 antibody levels. Further studies are required to improve care and therapeutics for patients with CHB who contracted COVID-19.
背景与目的
目前关于慢性乙型肝炎（CHB）患者感染奥密克戎BA.5后的临床数据有限。本研究旨在评估中国南方CHB合并奥密克戎BA.5感染患者的临床特征。
方法
本回顾性研究于2023年1月至3月对485名健康个体和553名CHB患者进行。测量了包括新冠病毒相关症状、严重急性呼吸综合征冠状病毒2（SARS-CoV-2）抗体水平、疫苗接种状况、肝功能以及乙型肝炎病毒（HBV）感染的病毒学标志物等临床特征。
结果
两组的新冠病毒相关症状模式相似，但发热情况除外，CHB患者中发热的发生率明显较低（85.4%对90.4%，P = 0.047），发热持续时间显著较短（中位数2.2（第25至75百分位数，1.0 - 3.0）天对2.3（1.0 - 3.0）天，P = 0.048），症状缓解时间也较短（9.2（5.0 - 14.0）天对11.1（5.0 - 14.0）天，P = 0.015）。两组的SARS-CoV-2抗体水平相当，但在加强疫苗接种后有所升高。在CHB患者中，无论使用恩替卡韦（ETV）还是替诺福韦（TFV）的核苷（酸）类似物治疗方案，奥密克戎BA.5感染后球蛋白（GLB）和乙型肝炎e抗体水平均显著升高。接受TFV治疗的CHB患者的SARS-CoV-2抗体水平显著高于接受ETV治疗的患者（1065.1（346.9 - 1188.5）COI对765.5（24.5 - 1119.1）COI，P = 0.025）。
结论
未观察到新冠病毒症状明显加重，同时新冠病毒加强疫苗接种有效。除GLB外，肝功能无明显变化。奥密克戎BA.5感染后，CHB患者中观察到HBV DNA增加所证明的HBV再激活。这些变化不受ETV与TFV给药的影响；然而，TFV导致SARS-CoV-2抗体水平显著升高。需要进一步研究以改善感染新冠病毒的CHB患者的护理和治疗。
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