Clinicopathologic characteristics of liver inflammation and fibrosis in 310 patients with chronic hepatitis B / 中南大学学报(医学版)

OBJECTIVES@#Long-term hepatitis B virus (HBV) infection can cause recurrent inflammation in the liver, and then develop into liver fibrosis, cirrhosis, and liver cancer. The hepatic pathological change is one of the important criteria for guiding antiviral therapy in patients with chronic hepatitis B (CHB). Due to the limitations of liver biopsy, it is necessary to find valuable non-invasive indicators to evaluate the hepatic pathological changes in CHB patients and guide the antiviral therapy. This study aims to analyze the clinical characteristics of different pathological changes in CHB patients, and to explore the factors influnencing the degree of liver inflammation and fibrosis in CHB patients with normal alanine aminotransferase (ALT).@*METHODS@#This retrospective study was conducted on 310 CHB patients. Liver biopsy was performed in all these patients. The clinical data of the patients were collected. The liver biopsy pathological results were used as the gold standard to analyze the relationship between clinical indicators and liver pathological changes. Then CHB patients with normal ALT were screened, and the independent factors influencing the degree of liver inflammation and fibrosis were explored.@*RESULTS@#Among the 310 patients with CHB, there were 249 (80.3%) patients with significant liver inflammation [liver inflammation grade (G) ≥2] and 119 (38.4%) patients with significant liver fibrosis [liver fibrosis stage (S) ≥2]. The results of univariate analysis of total samples showed that the ALT, γ-glutamyl transferase, alkaline phosphatase, and HBV DNA were related to the significant liver pathological changes. Among the 132 CHB patients with normal ALT, the patients with liver pathology G/S≥2, G≥2, and S≥2 were 80.3% (106/132), 68.2% (90/132), and 43.2% (57/132), respectively. The results showed that the independent influencing factor of significant liver inflammation was HBV DNA>2 000 U/mL (OR=3.592, 95% CI 1.534 to 8.409), and the independent influencing factors of significant liver fibrosis were elevated alkaline phosphatase level (OR=1.022, 95% CI 1.002 to 1.043), decreased platelet count (OR=0.990, 95% CI 0.982 to 0.998), and positive in hepatitis B e antigen (HBeAg) (OR=14.845, 95% CI 4.898 to 44.995). According to the multivariate analysis, a diagnostic model for significant liver fibrosis in CHB patients with normal ALT was established, and the area under the receiver operating characteristic curve was 0.844 (95% CI 0.779 to 0.910).@*CONCLUSIONS@#The liver pathological changes should be evaluated in combination with different clinical indicators. A considerable number of CHB patients with normal ALT still have significant liver pathological changes, which need to be identified and treated with antiviral therapy in time. Among them, HBV DNA>2 000 U/mL suggests the significant liver inflammation, and the diagnostic model for significant liver fibrosis based on alkaline phosphatase, platelet count, and HBeAg can help to evaluate the degree of liver fibrosis.

Seguimiento longitudinal de 64 niños crónicamente infectados por virus B, tratados y no tratados con interferon / Longitudinal follow up of 64 children chronically infected with hepatitis B virus; treated and not treated with interferon

Con la finalidad de contribuir a conocer el espectro de la enfermedad se presentan las características evolutivas de un grupo de niños crónicamente infectados con virus de hepatitis B (VHB), 38 de ellos recibieron tratamiento con interferon y 26 no lo recbieron. El tiempo mínimo de infección fue de 8 meses, la edad promedio fue de 4,7 años con ligero predominio del sexo masculino (39/25) y el tiempo promedio de observación fue de 5 años 3 meses (rango 6 meses-14 años). La muestra se dividió en dos grandes grupos: a) 40 pacientes AgeHB positivos, de los cuales 26 recibieron tratamiento y 14 no. b) 24 pacientes AgeHB negativos, 12 tratados y 12 sin tratamiento. La dosis fue de 5.000.000 unidades por metro cuadrado de superficie corporal 3 veces por semana durante 16 semanas. Los resultados no mostraron diferencias estadísticamente significativas que sugieran efectos favorables del INF en el logro de la seroconversión del Age ni del Ags, mientras que la edad si incluye significativamente en la seroconversión del Ags, por lo que se plantea si la seroconversión obtenida puede deberse más a la tendencia natural de la enfermedad a eliminar el virus que al efecto del inteferon. En el lapso de estudio solo un caso evolucionó a cirrosis (1,7 por ciento) y en ninguno se ha detectado hepatocarcinoma