慢性乙肝患者临床转归及影响因素分析

Clinical outcomes and influencing factors in chronic hepatitis B patients

目的通过基于医院门诊就诊的乙肝患者队列,开展随访研究,探讨门诊就诊的慢性乙肝患者HBV感染状况变化及其影响因素。方法以某三甲医院传染科门诊就诊的慢性乙型肝炎患者为观察队列,通过电话随访完成相关信息问卷调查表,并采集患者乙肝相关的检测结果与临床转归情况,分析慢性乙肝患者的临床转归及影响因素。结果564例随访对象中,血清学标志物的主要模式为“大三阳”占47.70%和“小三阳”占41.84%。多因素COX分析结果可见,HBeAg阴转的影响因素为曾住院(HR=0.54,95%CI:0.42~0.68)、HBsAg定量等级(HR=1.20,95%CI:1.04~1.38)、HBeAg定量等级(HR=0.79,95%CI:0.67~0.92)。随访期间患者住院的影响因素为年龄(HR=1.44,95%CI:1.07~1.92),HBsAg定量等级(HR=1.23,95%CI:1.01~1.50),家族成员肝硬化肝癌家族史(HR=2.97,95%CI:1.71~5.13)。结论影响乙肝患者临床转归的因素众多,通过对门诊就诊的慢性乙肝患者队列进行随访,可了解门诊就诊慢性乙肝患者HBV感染状况变化及其影响因素。

Objective Follow-up study was conducted to investigate the changes of HBV infection indicators and their influencing factors in chronic hepatitis B patients at outpatient clinics.Methods Patients with chronic hepatitis B who were treated in the outpatient department of a 3A level hospital were observed.The questionnaires were completed by telephone,and the results of hepatitis B related tests and clinical outcomes were collected to analyze the influencing factors of clinical outcomes of patients with chronic hepatitis B.Results Among status of HBV serological markers in 564 cases of follow-up subjects,the main serological patterns were HBsAg-positive,anti-HBs-negative,HBeAg-positive,anti-HBe-negative,and anti-HBc-positive patterns accounted for 47.70%,HBsAg-positive,anti-HBs-negative,HBeAg-negative,anti-HBe positive and anti-HBc positive patterns accounted for 41.84%.Multivariate COX analysis indicated that previous hospitalization(HR=0.54,95%CI:0.42-0.68),HBsAg quantitative level(HR=1.20,95%CI:1.04-1.38),HBeAg quantitative level(HR=0.79,95%CI:0.67-0.92)were HBeAg negative conversion influencing factors.The influencing factors of patients hospitalization during follow-up were age(HR=1.44,95%CI:1.07-1.92),HBsAg quantitative level(HR=1.23,95%CI:1.01-1.50),family members with history of cirrhosis or liver cancer(HR=2.97,95%CI:1.71-5.13).Conclusion Many factors influence the clinical outcomes of patients with hepatitis B.The follow-up of the chronic hepatitis B patients in the outpatient clinic could provided information to understand the changes of HBV infection status and its influencing factors.