重新评估HBV DNA阴性的无症状HBsAg携带者的抗病毒阈值：一项多中心组织病理学分析
Reevaluating antiviral thresholds in HBV DNA-negative inactive HBsAg carriers: a multicenter histopathological analysis.
作者信息
Ren Shan, Zheng Sujun, Zhang Xinyang, Fu Junliang, Fan Rongshan, Ruan Qingfa, Huang Wenqi, Gao Haibing, Xue Xiulan, Yang Fang, Xie Yao, Li Minghui, Chen Xinyue
机构信息
First Department of Liver Disease Center, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, P. R. China.
Department of Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, P. R. China.
出版信息
Virol J. 2025 Jul 10;22(1):235. doi: 10.1186/s12985-025-02853-0.
BACKGROUND
The definition of inactive HBsAg carriers (IHC) varies globally, particularly regarding HBV DNA thresholds. Whether HBV DNA negativity reliably predicts histological quiescence remains uncertain.
AIMS
This study evaluated liver pathology in IHC patients to reassess antiviral therapy thresholds.
METHODS
This multi-center, retrospective study included 231IHCs(2018-2023) stratified by HBV DNA negativity (< 20IU/mL). Liver biopsies assessed inflammation (G ≥ 2) and fibrosis (F ≥ 2); evident hepatic injury (EHI) was defined as G ≥ 2 and/or F ≥ 2. Multivariable models evaluated predictors.
RESULTS
Among 231 IHC patients(median age:43 years old; 95.2% ≥30 years old), 35.9%(83/231) were HBV DNA negative. The median HBsAg and HBV DNA level were 132 IU/ml and 94 IU/ml, respectively. Notably, EHI prevalence was significantly higher in HBV DNA negative patients than positive ones(44.9% vs. 31%, P = 0.04), driven by fibrosis (F ≥ 2: 42.2% vs. 21.6%, P < 0.001), challenging the assumption that HBV DNA negativity ensures low histological risk. Male sex, HBV DNA negativity, and elevated liver stiffness measurement(LSM) independently predicted EHI (OR = 3.37, AUC = 0.747).
CONCLUSION
HBV DNA negativity does not guarantee histological quiescence in inactive HBsAg carriers aged ≥ 30 years, with 44.9% exhibiting significant liver injury. In this population, LSM > 6.4 Kpa should prompt consideration of liver biopsy and/or initiation of antiviral therapy.
背景
非活动性HBsAg携带者（IHC）的定义在全球范围内存在差异，尤其是在HBV DNA阈值方面。HBV DNA阴性是否能可靠地预测组织学静止仍不确定。
目的
本研究评估了IHC患者的肝脏病理，以重新评估抗病毒治疗阈值。
方法
这项多中心回顾性研究纳入了2018年至2023年的231例IHC患者，并根据HBV DNA阴性（<20IU/mL）进行分层。肝活检评估炎症（G≥2）和纤维化（F≥2）；明显肝损伤（EHI）定义为G≥2和/或F≥2。多变量模型评估预测因素。
结果
在231例IHC患者中（中位年龄：43岁；95.2%≥30岁），35.9%（83/231）为HBV DNA阴性。HBsAg和HBV DNA的中位水平分别为132IU/ml和94IU/ml。值得注意的是，HBV DNA阴性患者的EHI患病率显著高于阳性患者（44.9%对31%，P=0.04），这是由纤维化驱动的（F≥2：42.2%对21.6%，P<0.001），这对HBV DNA阴性可确保低组织学风险这一假设提出了挑战。男性、HBV DNA阴性和肝脏硬度测量值（LSM）升高独立预测EHI（OR=3.37，AUC=0.747）。
结论
对于年龄≥30岁的非活动性HBsAg携带者，HBV DNA阴性并不能保证组织学静止，44.9%的患者存在明显肝损伤。在这一人群中，LSM>6.4Kpa应促使考虑进行肝活检和/或开始抗病毒治疗。
Zotero 插件