某院乙肝病毒携带者进展为乙肝患者的随访研究

Follow-up Study on Hepatitis B Virus Carriers Progressing to Chronic Hepatitis B

目的观察乙型肝炎病毒(HBV)慢性感染者中健康携带者进展为慢性乙型肝炎(CHB)患者的发生率及影响因素。方法以2014年1—8月期间在河南大学淮河医院门诊确诊的623例HBV慢性感染健康携带者为前瞻性观察队列,在2016年6—12月间对所有观察对象进行随访体检,判断临床转归。根据健康携带者是否进展为CHB,将观察对象分为未进展组和进展组。比较两组临床资料,采用Cox回归分析HBV携带者进展为CHB的影响因素。结果两组患者的性别、基线HBeAg阳性率和HBV-DNA值比较,差异均有统计学意义(P<0.05),具体而言,进展组的男性、HBeAg阳性率与≥200 000 IU/ml的比例分别为47.0%、10.6%和10.2%,高于非进展组的32.3%、6.2%和1.8%。Cox回归分析结果表明,女性是HBV携带者进展为CHB的独立保护因素,而HBV-DNA载量升高是独立危险因素(P<0.05)。HBeAg仍然阳性的HBV-DNA载量均显著高于同期的HBeAg阴转者,差异均有统计学意义(P<0.05)。进展组的211例基线HBeAg阴性者中有4例发生HBeAg阳转,207例HBeAg持续阴性。HBeAg阳转者随访时的HBV-DNA载量显著高于HBeAg持续阴性者,差异有统计学意义(P<0.05)。结论在两年的随访时间里约有1/3的HBV携带者进展为CHB,性别和HBV-DNA载量是进展发生的独立影响因素,建议定期对HBV携带者检查HBV-DNA载量、血清学标志物和B超,尤其是男性携带者。

OBJECTIVE To investigate the incidence and related factor of hepatitis B virus（HBV）carriers progressing to chronic hepatitis B（CHB）in sentinel hospital.METHODS 623 individuals with HBV carriers diagnosed in Huaihe Hospital of Henan University from January to August 2014 were established as a prospective cohort.They were followed up again from June to December 2016 to determine clinical outcome,then divided into progress group（n=236）and non-progress group（n=387）whether they had progressed to CHB or not.The clinical data were compared between two groups,and Cox regression analysis was performed to investigate the related factors of HBV carriers progressing to CHB.RESULTS There were significant differences in sex,positive rates of HBeAg and HBV DNA value between two groups（P〈0.05）,and in particular,the rate of male and HBV DNA value≥200 000 IU/ml in progressive group were 47%,10.6%,10.2%,and higher than 32.3%,6.2%,1.8% in the non-progress group.Cox regression analysis result showed that women was the independent protective factor for HBV carriers progressing to CHB,and HBV-DNA load increased was the independent risk factor（P〈0.05）.Multivariate logistic regression analysis showed that female and HBV-DNA load were independent factors affecting the progression of HBV to CHB（P〈0.05）.HBV-DNA values in patients with persistent positive HBeAg were significantly higher than that in the same time of cases with negative conversion HBeAg（P〈0.05）.In 211 patients with baseline negative HBeAg of progressive group,4 patients had positive followed-up HBeAg and 207 cases had persistent negative HBeAg.Followed-up HBV-DNA values in patients with positive conversion HBeAg were significantly higher than that in patients with persistent negative HBeAg （P〈 0.05）.CONCLUSION 1/3 HBV carriers would progress to CHB during a follow-up period of about two years.Gender and HBV-DNA value were independent factors of the progression,so it recommend HBV carriers to regularly detect the HBV-DNA load,serological markers and type-B ultrasonic,especially for males.