基于高敏检测的乙肝肝硬化低病毒血症患者的预后分析

Prognostic analysis of hepatitis B cirrhosis patients with hypovolemia based on hypersensitivity test

目的 探讨经核苷类药物治疗的乙肝肝硬化低病毒血症患者的临床特点及预后。方法 收集2020年至2022年就诊于太原市第三人民医院的经核苷类药物治疗乙型肝炎肝硬化患者,通过乙肝病毒高敏检测分为未测到靶标组、低于检测下限组、低病毒血症组,平均随访48周,观察患者临床特点、肝硬化相关并发症、肝细胞癌(HCC)发生率,评估其预后及影响因素。结果 251例经核苷类药物治疗乙肝肝硬化患者中低病毒血症组(HBV DNA 10~2 000 U/ml)25例,低于检测下限组(HBV DNA<10 U/ml)107例,未测到靶标组(HBV DNA未检测到)119例,3组间丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、白蛋白(ALB)、总胆红素(TBIL)、凝血酶原活动度(PTA)%差异有统计学意义。3组患者既往核苷类药物治疗史及干扰素治疗史具有统计学意义,多数患者接受1~2种核苷类药物抗病毒治疗,且过半患者可达到HBV DNA检测不到的效果。随访期间3组患者均发现新增肝硬化相关并发症,38例(15.1%)发生HCC,其中7例死亡。结论 HBV DNA控制越好,肝损伤越轻,肝脏合成功能越好。接受抗病毒治疗核苷类药物(NAs)或干扰素(IFN)能显著降低乙肝病毒DNA。乙型肝炎肝硬化患者不论抗病毒治疗完全应答与否,均应定期检查,及早发现肝硬化相关并发症、原发性肝癌并予积极治疗,降低相关死亡率。

Objective To investigate the clinical characteristics and prognosis of hepatitis B cirrhosis patients with lymphatic leukaemia virus(LLV)treated with nucleotide analogs(NAs).Methods NAs-treated patients with hepatitis B cirrhosis admitted to the Third People′s Hospital of Taiyuan from 2020 to 2022 were collected and divided into undetected target group,VLLV group,and LLV group through hypersensitivity detection of hepatitis B virus(HBV).The patients were followed up for an average of 48 weeks to observe the clinical characteristics,complications related to cirrhosis,and the incidence of hepatocellular carcinoma(HCC),and evaluate the prognosis and influencing factors.Results Among 251 patients with hepatitis B cirrhosis treated with NAs,25 were in the LLV group(HBV DNA10-2000 U/ml),107 were VLLV group(HBV DNA<10 U/ml),and 119 were in the undetected target group(HBV DNA undetected).Alanine aminotransferase,aspartate aminotransferase,serum albumin,total bilirubin,and prothrombin activity(PTA)%were statistically significant among the three groups.The history of NAs therapy and interferon(IFN)therapy in the 3 groups had statistical significance,and most of the patients received 1-2 kinds of NAs antiviral therapy,and more than half of the patients could achieve the effect of HBV DNA undetectable.During follow-up,new cirrhosis-related complications were found in all three groups,and 38 patients(15.1%)developed HCC,including 7 deaths.Conclusion The better the control of HBV DNA,the lighter the liver injury and the better the liver synthesis function.Receiving antiviral therapy(NAs or IFN)can significantly reduce HBV DNA.Patients with hepatitis B cirrhosis,regardless of complete response to antiviral therapy,should be regularly examined,for early detection of cirrhosis-related complications and HCC,and take active treatment to reduce related mortality.