365例慢性乙型肝炎患者的远期随访

Long-term follow-up of patients with chronic hepatitis B

目的 通过对慢性乙型肝炎患者的自然病程进行研究，为其预后评估提供依据。方法 采用回顾性方法对365例经组织学确诊的慢性乙型肝炎患者进行5～15年的随访，每年采血检测肝功能、病毒学指标及HBVDNA定量。结果 365例慢性乙型肝炎患者累计死亡34例（9．30％），转为肝硬化60例（13．97％），肝癌18例（4．65％）。累计5、10、15年生存率分别为96．13％、86．85％、82．17％，累计肝癌5、10、15年发生率分别为O％、2．17％、9．64％。累计HBsAg阴转率10．07％，HBeAg阴转率为78．70％，HBV DNA转阴率为68．6％。肝脏炎症活动程度与肝脏硬化、死亡有明显的关系，但与癌变关系不明显。结论 慢性乙型肝炎的远期预后不良，控制肝脏炎症对延缓疾病发展和降低死亡率有宜。

Objective To analyze the natural history of chronic hepatitis B. Methods A cohort of 365 chronic hepatitis B patients proven with biopsy were followed up by retrospective study. The follow-up time was 5 ～ 15 years. The serum samples were collected and tested for liver function, markers of HBV and HBV DNA level once a year. Results In 365 chronic hepatitis B patients, 34 （9.30 % ） died, 60 （ 13.91% ） developed liver cirrhosis, and 18 （4.65 % ） hepatocellular carcinoma. The cumulative survival probabilities were 96.13% ,86.85% and 82.17% in 5,10, and 15 years, respectively. The cumulative probabilities of hepatocellular carcinoma were 0% ,2.17% ,and 9.14% in 5,10, and 15 years, respectively. HBsag, HBeAg and HBV DNA seroconversion happened in 10.07% ,78.7% ,and 68.6% of patients, respectively. The degree of liver histological injury were closely related to liver cirrhosis, death rate, but no remarkable relationship with occurance of hepatocellular carcinoma. Conclusion The long-term outcome of chronic hepatitis B is poor. Control of the liver injury is helpful to delay the disease development and the reduction of death rate.