长期抗病毒治疗的慢性乙型肝炎患者病情进展影响因素初探

Influencing factors of disease progression in patients with chronic hepatitis B treated with long-term antiviral therapy

目的探讨长期抗病毒治疗对由慢性乙型肝炎(CHB)进展为肝硬化或由代偿性肝硬化进展为失代偿性肝硬化的影响,并探索长期抗病毒治疗的CHB患者病情进展的影响因素。方法基于真实世界研究方法,采用回顾性研究,以2006年10月-2021年10月在宜昌市夷陵医院感染性疾病科长期接受抗病毒治疗的92例CHB患者为研究对象,通过比较观察终点与起始抗病毒治疗时的病情,划分为进展恶化组(27例)和未进展组(65例),以进展为肝硬化(5期)或死亡的时间为观察终点,未进展为肝硬化(5期)或死亡的患者以2021年10月为观察终点,规范化、回顾性收集患者初诊至观察终点期间的临床资料,运用SPSS 26.0进行统计分析,比较两队列中是否规律抗病毒治疗、饮酒、家族史、耐药、起始治疗时的病情以及年龄对CHB患者病情进展的影响,从而确定CHB患者病情进展的影响因素。结果92例CHB患者男性70例(76%),女性22例(24%),随访时间为5~16年,中位随访时间为9年。截止观察终点时病情明显进展恶化27例(29%),未明显进展83例(71%)。应用χ^(2)检验对二组进行分析,不规律治疗组(χ^(2)=5.050,P=0.025)、饮酒组(χ^(2)=3.921,P=0.048)、有家族史组(χ^(2)=3.940,P=0.047)、耐药组(χ^(2)=6.185,P=0.013)CHB患者病情进展的发生率明显高于对照组(P<0.05);而规律抗病毒治疗的患者,起动抗病毒治疗时年龄>40岁(χ^(2)=9.113,P=0.004)及病情为肝硬化3、4期的患者(χ^(2)=8.134,P=0.004)病情进展的发生率明显高于对照组(P<0.05)。应用logistic回归分析对CHB患者病情进展进行多因素分析,起始抗病毒治疗的年龄(R=1.147,P<0.001)、治疗依从性(R=5.443,P=0.014)、起始抗病毒治疗时患者病情轻重(R=0.434,P=0.039)、耐药(R=8.862,P=0.032)与患者病情进展有相关性(P<0.05)。结论长期抗病毒治疗可有效延缓CHB患者病情进展。

Objective To investigate the effects of long-term antiviral treatment on the progression of chronic hepatitis B(CHB)patients to cirrhosis or from compensated cirrhosis to decompensated cirrhosis,and investigate the influencing factors of disease progression.Methods Based on the real world research method,a retrospective study was conducted.A total of 92 CHB patients treated in our hospital from October 2006 to October 2021 were included.They were divided into progressive deterioration group(27 cases)and non progressive group(65 cases)according to the condition at initiation and endpoints of antiviral therapy.The end point was the occurrence of cirrhosis(stage 5)or death,and October 2021 as the observation endpoint for patients who did not progress to cirrhosis(stage 5)or death.The clinical data from the initial observation to the end point were collected and analyzed retrospectively.The data were analyzed by SPSS 26.The effects of regular antiviral treatment,alcohol consumption,family history,drug resistance,initial treatment condition and age on the progression of CHB were compared between the 2 groups.Analyze the influencing factors of disease progression in CHB patients.Results(1)There were 70 males(76%)and 22 females(24%)were followed up for 5-16 years with a median follow-up of 9 years.By the end point of observation,27 cases(29%)had significantly progressed and 83(71%)cases had not significantly progressed by the observation endpoint.(2)The results ofχ^(2) test showed that the incidence rate of disease progression in irregular treatment group(χ^(2)=5.050,P=0.025),drinking group(χ^(2)=3.921,P=0.048),with family history group(χ^(2)=3.940,P=0.047),drug-resistant group(χ^(2)=6.185,P=0.013)was significantly higher than that in the control group(P<0.05);In regular antiviral treatment group,the incidence rate of disease progression in patients with age more than 40 years old(χ^(2)=9.113,P=0.004)and patients with cirrhosis stages 3 and 4 at the start of antiviral therapy(χ^(2)=8.134,P=0.004)was significantly higher than that of the control group(P<0.05);(3)The results of logistic regression analysis showed that age at initiation of antiviral therapy(R=1.147,P<0.01),compliance with treatment(R=5.443,P=0.014),severity of the patient at the initiation of antiviral treatment(R=0.434,P=0.039),drug resistance(R=8.862,P=0.032)was correlated with the patient's disease progression(P<0.05).Conclusion Long-term antiviral treatment can effectively delay the progression of CHB patients.