Chronic hepatitis B virus infection in Eastern Ethiopia:Clinical characteristics and determinants of cirrhosis

BACKGROUND Chronic hepatitis B(CHB)virus infection is a major cause of liver-associated morbidity and mortality,particularly in low-income countries.A better understanding of the epidemiological,clinical,and virological characteristics of CHB will guide appropriate treatment strategies and improve the control and management of CHB in Ethiopia.AIM To investigate the characteristics of CHB in Eastern Ethiopia and assess the efficacy and safety of antiviral treatment.METHODS This cohort study included 193 adults who were human immunodeficiency virus-negative with CHB between June 2016 and December 2019.Baseline assessments included chemistry,serologic,and viral markers.χ^(2) tests,Mann-Whitney U tests,and logistic regression analyses were used to identify the determinants of cirrhosis.Tenofovir disoproxil fumarate(TDF)was initiated using treatment criteria from the Ethiopian CHB pilot program.RESULTS A total of 132 patients(68.4%)were men,with a median age of 30 years[interquartile range(IQR):24-38].At enrollment,60(31.1%)patients had cirrhosis,of whom 35(58.3%)had decompensated cirrhosis.Khat use,hepatitis B envelope antigen positivity,and a high viral load were independently associated with cirrhosis.Additionally,66 patients(33.4%)fulfilled the treatment criteria and 59(30.6%)started TDF.Among 29 patients who completed 24 months of treatment,the median aspartate aminotransferase to platelet ratio index declined from 1.54(IQR:0.66-2.91)to 1.10(IQR:0.75-2.53)(P=0.002),and viral suppression was achieved in 80.9%and 100%of patients after 12 months and 24 months of treatment,respectively.Among the treated patients,12(20.3%)died within the first 6 months of treatment,of whom 8 had decompensated cirrhosis.CONCLUSION This study highlights the high prevalence of cirrhosis,initial mortality,and the efficacy of TDF treatment.Scaling up measures to prevent and control CHB infections in Ethiopia is crucial.

Chronic Hepatitis B in Indian Americans: Lack of Screening and Poor Linkage to Care

Background: Chronic hepatitis B (CHB) is a major cause of liver-related morbidity and mortality in the United States (US) and globally. CHB disproportionately affects Asian Americans and many other immigrant minority populations, primarily owing to the high prevalence of CHB in their countries of origin. India is a country with a medium-to-high prevalence of hepatitis B (HB) (>2%) and has over 40 million people infected with hepatitis B virus (HBV), with more than 115,000 deaths annually from HBV-related complications. Indian Americans are one of the largest immigrant populations in the US but remain underdiagnosed and poorly linked to clinical care. We, therefore, assessed the HBV prevalence and evaluated the linkage-to-care (LTC) among Indian Americans to develop strategic plans to reduce the impact of HBV in the US. Methods: Between April 2022 and January 2024, serologic screening and surveys were provided to 328 Indian American adults (age 20 - 80) in New York City. All participants were tested for a triple panel consisting of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core IgG antibody (anti-HBc). A survey was conducted on the subjects chronically infected with HBV regarding their histories of infection. Self-administered questionnaires were employed to evaluate demographic and epidemiologic characteristics. Results: Of 328 screened and evaluated (246 males and 82 females), 10 (3.0%) were HBV-infected, 222 (67.7%) were susceptible to HBV, and 96 (29.3%) were immune. The prevalence of chronic HBV varied between the age groups: 4.6% (age 20 - 40), 3.4% (age 41 - 60), and 1.7% (age 61 - 80). Of 10 chronically infected, only two subjects had been previously diagnosed but were not engaged in care. Conclusion: HBV disproportionately affects Asian Americans, primarily owing to immigration from parts of the world where the disease is endemic. Indian Americans belong to an intermediate-risk group, with an HBV prevalence of >2%, but remain underdiagnosed and poorly linked to care. Our pilot study on Indian American populations, the first of its kind, demonstrates a 3% prevalence of CHB, none of whom are linked to care. In addition, this population has a high percentage of unimmune subjects, creating a large reservoir for future infection. With the growing population of Indian Americans, our findings can be used to develop community-based strategies for HBV screenings and LTC that target high-risk groups.

Factors Associated with Renal Impairment in Patients on Tenofovir for Chronic Hepatitis B in Yaoundé (Cameroon)

Background: Tenofovir (TFV) is widely used to treat patients with hepatitis B virus (HBV) infection. But kidney abnormalities are the main concern using this drug. Few studies have described the renal impairment due to the TFV in chronic hepatitis B (CHB) in Sub-Saharan Africa. The objective was to evaluate factors associated with renal impairment observed in patients on TFV for CHB. Method: It was a hospital based cross sectional prospective study carried out from June 2023 to July 2023 in Yaoundé (Cameroon) and included any patient treated with TFV for CHB during at least a period of 6 months. For each participant, we collected in the medical report socio-demographic data, clinical data, baseline creatinine, treatment information (type of TFV which was Disoproxil Fumarate (TDF) or Alafenamide (TAF), duration). Then, we collected blood samples to measure serum creatinine and phosphate levels and urine dipstick analysis. Factors associated with renal impairment were assessed with the Odds Ratio. A p value of Results: A total of 60 participants were included. The median age was 44 years [36-55] and median duration of TFV therapy was 17.5 months [11.7-25.7]. The prevalence of reduced eGFR (Conclusion: Kidney function was impaired in some patients receiving TFV for CHB. It should be monitored, particularly after 36 months and for those receiving TDF prodrug.

Impact of metabolic dysfunction-associated steatotic liver disease on the efficacy of immunotherapy in patients with chronic hepatitis B-related hepatocellular carcinoma

Objective:To investigate the impact of metabolic dysfunction-associated steatotic liver disease(MASLD)on the efficacy of immune checkpoint inhibitor(ICI)-based therapy in patients with chronic hepatitis B(CHB)-related hepatocellular carcinoma(HCC).Methods:A total of 155 patients with CHB-related HCC who received ICI–based therapy(in the Department of Hepatology,Tianjin Second People’s Hospital and Department of Hepatobiliary Oncology,Tianjin Medical University Cancer Institute&Hospital)between April 2021 and December 2023 were evaluated.Patients were divided into two groups:MASLD concurrent with CHB[MASLD-CHB](n=38),and CHB(n=117).Results:The median progression-free survival(PFS,6.9 months vs.9.3 months;P=0.001),progressive disease(57.89%vs.37.61%;P=0.028),and disease control rate(42.11%vs.62.39%;P=0.028)in the MASLD-CHB group were significantly worse than the CHB group.The median overall survival was not attained.The percentage of CD4+PD1+(17.56%vs.8.89%;P<0.001)and CD8+PD1+T cells(10.50%vs.7.42%;P=0.005)in patient samples from the MASLD-CHB group were significantly higher than the CHB group.Concurrent MASLD[hazard ratio(HR)=1.921;95%CI,1.138–3.245;P=0.015]and alpha-fetoprotein levels after 3 months of treatment(HR=2.412;95%CI,1.360–4.279;P=0.003)were independent risk factors for PFS in all patients.Conclusions:ICI-based therapy in patients with CHB-related HCC and concurrent MASLD resulted in poorer efficacy and shorter PFS compared to patients with CHB-related HCC alone.

Chronic hepatitis B:Prevent,diagnose,and treat before the point of no return

Hepatitis B remains a significant global health challenge,contributing to substantial morbidity and mortality.Approximately 254 million people world-wide live with Chronic hepatitis B(CHB),with the majority of cases occurring in sub-Saharan Africa and the Western Pacific regions.Alarmingly,only about 13.4%of the individuals infected with this disease have been diagnosed,and awareness of hepatitis B virus(HBV)infection status is as low as 1%in sub-Saharan Africa.In 2022,CHB led to 1.1 million deaths globally.The World Health Organization(WHO)has set a target of eliminating hepatitis B as a public health concern by 2030;however,this goal appears increasingly unattainable due to multiple challenges.These challenges include low vaccination coverage;a large number of undiagnosed cases;a low proportion of patients eligible for treatment under current guidelines;limited access to healthcare;and the costs associated with lifelong treatment.Treatment of HBV can yield significant clinical benefits within a long window of opportunity.However,the benefits of therapy are markedly diminished when the disease is detected at the advanced cirrhosis stage.This editorial aim to highlight the current challenges in hepatitis care and the necessary steps to achieve the WHO's hepatitis elimination goals for 2030.

Effectiveness and safety of tenofovir amibufenamide in chronic hepatitis B patients

This letter to the editor relates to the study entitled“Tenofovir amibufenamide vs tenofovir alafenamide for treating chronic hepatitis B:A real-world study”,which was recently published by Peng et al.Hepatitis B virus infection represents a significant health burden worldwide and can lead to cirrhosis and even liver cancer.The antiviral drugs currently used to treat patients with chronic hepatitis B infection still have many side effects,so it is crucial to identify safe and effective drugs to inhibit viral replication.

Prediction model for hepatitis B e antigen seroconversion in chronic hepatitis B with peginterferon-alfa treated based on a responseguided therapy strategy

BACKGROUND Models for predicting hepatitis B e antigen(HBeAg)seroconversion in patients with HBeAg-positive chronic hepatitis B(CHB)after nucleos(t)ide analog treatment are rare.AIM To establish a simple scoring model based on a response-guided therapy(RGT)strategy for predicting HBeAg seroconversion and hepatitis B surface antigen(HBsAg)clearance.METHODS In this study,75 previously treated patients with HBeAg-positive CHB underwent a 52-week peginterferon-alfa(PEG-IFNα)treatment and a 24-wk follow-up.Logistic regression analysis was used to assess parameters at baseline,week 12,and week 24 to predict HBeAg seroconversion at 24 wk post-treatment.The two best predictors at each time point were used to establish a prediction model for PEG-IFNαtherapy efficacy.Parameters at each time point that met the corresponding optimal cutoff thresholds were scored as 1 or 0.RESULTS The two most meaningful predictors were HBsAg≤1000 IU/mL and HBeAg≤3 S/CO at baseline,HBsAg≤600 IU/mL and HBeAg≤3 S/CO at week 12,and HBsAg≤300 IU/mL and HBeAg≤2 S/CO at week 24.With a total score of 0 vs 2 at baseline,week 12,and week 24,the response rates were 23.8%,15.2%,and 11.1%vs 81.8%,80.0%,and 82.4%,respectively,and the HBsAg clearance rates were 2.4%,3.0%,and 0.0%,vs 54.5%,40.0%,and 41.2%,respectively.CONCLUSION We successfully established a predictive model and diagnosis-treatment process using the RGT strategy to predict HBeAg and HBsAg seroconversion in patients with HBeAg-positive CHB undergoing PEG-IFNαtherapy.

Liver stiffness in hepatocellular carcinoma and chronic hepatitis patients:Hepatitis B virus infection and transaminases should be considered

BACKGROUND Liver condition is a crucial prognostic factor for patients with hepatocellular carcinoma(HCC),but a convenient and comprehensive method to assess liver condition is lacking.Liver stiffness(LS)measured by two-dimensional shear wave elastography may help in assessing liver fibrosis and liver condition.Chronic hepatitis B(CHB)is an important risk factor for HCC progression,but LS was found to be less reliable in assessing liver fibrosis following hepatitis viral eradication.We hypothesize that the status of hepatitis virus infection would affect the accuracy of LS in assessing the liver condition.AIM To test the feasibility and impact factors of using LS to assess liver condition in patients with HCC and CHB.METHODS A total of 284 patients were retrospectively recruited and classified into two groups on the basis of serum CHB virus hepatitis B virus(HBV)-DNA levels[HBV-DNA≥100.00 IU/mL as Pos group(n=200)and<100.00 IU/mL as Neg group(n=84)].Correlation analyses and receiver operating characteristic analyses were conducted to evaluate the relationship between LS and liver condition.RESULTS A significant correlation was found between LS and most of the parameters considered to have the ability to evaluate liver condition(P<0.05).When alanine aminotransferase(ALT)concentrations were normal(≤40 U/L),LS was correlated with liver condition indices(P<0.05),but the optimal cutoff of LS to identify a Child-Pugh score of 5 was higher in the Neg group(9.30 kPa)than the Pos group(7.40 kPa).When ALT levels were elevated(>40 U/L),the correlations between LS and liver condition indices were not significant(P>0.05).CONCLUSION LS was significantly correlated with most liver condition indices in patients with CHB and HCC.However,these correlations varied according to differences in HBV-DNA and transaminase concentrations.

Quantitative hepatitis B core antibody and quantitative hepatitis B surface antigen:Novel viral biomarkers for chronic hepatitis B management

The management of hepatitis B virus(HBV)infection now involves regular and appropriate monitoring of viral activity,disease progression,and treatment response.Traditional HBV infection biomarkers are limited in their ability to predict clinical outcomes or therapeutic effectiveness.Quantitation of HBV core antibodies(qAnti-HBc)is a novel non-invasive biomarker that may help with a variety of diagnostic issues.It was shown to correlate strongly with infection stages,hepatic inflammation and fibrosis,chronic infection exacerbations,and the presence of occult infection.Furthermore,qAnti-HBc levels were shown to be predictive of spontaneous or treatment-induced HBeAg and HBsAg seroclearance,relapse after medication termination,re-infection following liver transplantation,and viral reactivation in the presence of immunosuppression.qAnti-HBc,on the other hand,cannot be relied on as a single diagnostic test to address all problems,and its diagnostic and prognostic potential may be greatly increased when paired with qHBsAg.Commercial qAnti-HBc diagnostic kits are currently not widely available.Because many methodologies are only semi-quantitative,comparing data from various studies and defining universal cut-off values remains difficult.This review focuses on the clinical utility of qAnti-HBc and qHBsAg in chronic hepatitis B management.

Liver histological changes in untreated chronic hepatitis B patients in indeterminate phase

BACKGROUND Studies with large size samples on the liver histological changes of indeterminate phase chronic hepatitis B(CHB)patients were not previously conducted.AIM To assess the liver histological changes in the indeterminate phase CHB patients using liver biopsy.METHODS The clinical and laboratory data of 1532 untreated CHB patients were collected,and all patients had least once liver biopsy from January 2015 to December 2021.The significant differences among different phases of CHB infection were compared with t-test,and the risk factors of significant liver histological changes were analyzed by the multivariate logistic regression analysis.RESULTS Among 1532 untreated CHB patients,814(53.13%)patients were in the indeterminate phase.Significant liver histological changes(defined as biopsy score≥G2 and/or≥S2)were found in 488/814(59.95%)CHB patients in the indete-rminate phase.Significant liver histological changes were significant differences among different age,platelets(PLTs),and alanine aminotransferase(ALT)subgroup in indeterminate patient.Multivariate logistic regression analysis indicated that age≥40 years old[adjust odd risk(aOR),1.44;95%confidence interval(CI):1.06-1.97;P=0.02],PLTs≤150×10^(9)/L(aOR,2.99;95%CI:1.85-4.83;P<0.0001),and ALT≥upper limits of normal(aOR,1.48;95%CI:1.08,2.05,P=0.0163)were independent risk factors for significant liver histological changes in CHB patients in the indeterminate phase.CONCLUSION Our results suggested that significant liver histological changes were not rare among the untreated CHB patients in indeterminate phase,and additional strategies are urgently required for the management of these patients.

Chronic hepatitis B and occult infection in chemotherapy patients-evaluation in oncology and hemato-oncology settings:The CHOICE study

BACKGROUND Reactivation of hepatitis B virus(HBV)infection is a well-known risk that can occur spontaneously or following immunosuppressive therapies,including cancer chemotherapy.HBV reactivation can cause significant morbidity and even mortality,which are preventable if at-risk individuals are identified through screening and started on antiviral prophylaxis.AIM To determine the prevalence of chronic HBV(CHB)and occult HBV infection(OBI)among oncology and hematology-oncology patients undergoing chemo-therapy.METHODS In this observational study,the prevalence of CHB and OBI was assessed among patients receiving chemotherapy.Serological markers of HBV infection[hepatitis B surface antigen(HBsAg)/anti-hepatitis B core antigen(HBc)]were evaluated for all patients.HBV DNA levels were assessed in those who tested negative for HBsAg but positive for total anti-HBc.RESULTS The prevalence of CHB in the study cohort was determined to be 2.3%[95%confidence interval(95%CI):1.0-4.2].Additionally,the prevalence of OBI among the study participants was found to be 0.8%(95%CI:0.2-2.3).CONCLUSION The findings of this study highlight the importance of screening for hepatitis B infection in oncology and hematology-oncology patients undergoing chemotherapy.Identifying individuals with CHB and OBI is crucial for implementing appropriate antiviral prophylaxis to prevent the reactivation of HBV infection,which can lead to increased morbidity and mortality.

慢性乙型肝炎患者血清HBsAg与单个核细胞乙型肝炎病毒RNA水平对聚乙二醇干扰素治疗效果的预测价值

目的探讨慢性乙型肝炎患者外周血清HBsAg、乙型肝炎病毒(HBV)DNA与血清HBV RNA及单个核细胞(PBMC)HBV RNA的关系。方法50例慢性乙型肝炎患者,给予Peg-IFNα-2b 180μg皮下注射,每周一次,分别在初始治疗、24周和48周,检测患者血清HBV五项、肝功能、HBV DNA、HBV RNA及PBMC中HBV RNA的变化。结果患者三个时间段的生化指标ALT、AST、TBIL、AKP及GGT比较差异无统计学意义(P>0.05);免疫学标志物HBsAg、HBsAb、HBeAg、HBeAb差异有统计学意义(P<0.05);血清HBV DNA及HBV RNA与PBMC HBV RNA差异有显著统计学意义(P<0.001)。结论Peg-IFNα-2b抗病毒治疗各时间段,肝功能转氨酶无显著变化;治疗24周,血HBsAg、HBV DNA与HBV RNA及PBMC HBV RNA快速下降,有显著相关性;治疗48周,血清HBsAg、HBV DNA与HBV RNA及PBMC HBV RNA相关性减弱。因此,24周HBV RNA下降幅度优于48周,更能预测临床治愈。

慢性HBV感染者外周血可诱导共刺激分子在CD8+ T淋巴细胞的表达及其临床意义

目的 探讨慢性乙型肝炎病毒(HBV)感染者外周血可诱导共刺激分子(ICOS)在CD8+T淋巴细胞的表达特点及临床意义。方法 选取2017年5月—2018年10月就诊的慢性乙型肝炎(CHB)100例、HBV-肝硬化(LC)25例和HBV-慢加急(或亚急)性肝衰竭(ACLF)26例分别纳入CHB组、HBV-LC组和HBV-ACLF组,健康对照(NC)组35例来自同期门诊体检健康者。采用流式细胞仪检测各组ICOS在CD8+T淋巴细胞的表达情况;分析CD8+T淋巴细胞ICOS表达水平与慢性HBV感染者疾病严重程度、HBV-ACLF预后及并发症的相关性;动态观察HBV-ACLF患者治疗过程中CD8+T淋巴细胞ICOS表达变化。结果 HBV-ACLF组外周血CD8+T淋巴细胞ICOS表达比率及平均荧光强度(MFI)均高于CHB组、HBV-LC组和NC组(P<0.05)。慢性HBV感染者ICOS的MFI与白蛋白、胆碱酯酶、总胆固醇、血红蛋白呈负相关(r=-0.263、-0.269、-0.273、-0.302,P=0.003、0.003、0.011、0.004);与直接胆红素、天冬氨酸转氨酶、凝血酶原时间、国际标准化比值呈正相关(r=0.248、0.208、0.331、0.315,P=0.005、0.020、0.003、0.009);与HBV-DNA、腹水及感染无明显相关性(P>0.05)。治疗过程中,HBV-ACLF患者ICOS的MFI无明显改变。但生存组ICOS的MFI在治疗第1周时较治疗前上升(P<0.05)。结论 HBV-ACLF患者外周血CD8+T淋巴细胞ICOS的表达水平明显升高,并与肝脏合成功能、炎症程度及预后相关,治疗早期ICOS水平变化有助于预测慢性HBV感染者的预后。

CHB合并EBV感染患者外周血双阴性T淋巴细胞和滤泡辅助性T细胞水平及其临床意义

目的评价慢性乙型病毒性肝炎(CHB)合并爱泼斯坦-巴尔病毒(EBV)感染患者外周血双阴性T淋巴细胞(DN T)、滤泡辅助性T细胞(Tfh)和CD4+T细胞水平以及CD4+/CD8+比值(CD4-CD8 Ratio)变化,并分析其与肝功能各项指标的相关性,探讨其临床意义。方法收集2021年10月至2023年8月南京中医药大学附属医院30例CHB合并原发性EBV感染患者(CHB+EBV组)、30例CHB患者(CHB组)及30名健康对照者(对照组)的外周血,采用流式细胞术检测外周血单个核细胞(PBMC)中Tfh细胞和DN T细胞、CD4+细胞、CD8+的水平,使用生化分析仪检测肝功能指标:天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、碱性磷酸酶(ALP)、直接胆红素(DBIL)、总胆红素(TBIL)、间接胆红素(IBIL)。结果外周血Tfh细胞水平:CHB+EBV组>CHB组>对照组,外周血DN T细胞水平:CHB组>CHB+EBV组>对照组,外周血CD4+T细胞水平:对照组>CHB组>CHB+EBV组,CD4+/CD8+比值:对照组>CHB组>CHB+EBV组,差异有统计学意义(P<0.05)。CHB+EBV组患者血液中ALT、AST、TBIL、DBIL、IBIL和ALP水平均明显高于CHB组和对照组(P<0.05)。相关性分析结果显示,患者外周血Tfh细胞与血液中ALT、AST、ALP、TBIL、DBIL和IBIL呈正相关(P<0.05)。DNT细胞与血ALT,AST,TBIL,DBIL和IBIL呈正相关(P<0.05),但与ALP无明显相关性(P>0.05)。CD4+细胞及CD4+/CD8+值与血ALT,AST,ALP,TBIL,DBIL及IBIL呈负相关(P<0.05)。结论双阴性T淋巴细胞和滤泡辅助性T细胞参与了CHB合并EBV感染免疫进程,且与患者肝损害有关。

入院时血清TGF-β1、Smad2、Smad3、HA、LN、PCⅢ、CⅣ水平与CHB肝纤维化严重程度的相关性及对疾病预后的预测价值

目的探讨入院时血清转化生长因子-β1(TGF-β1)、Smad同源蛋白2(Smad2)、Smad同源蛋白3(Smad3)及透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、层黏连蛋白(LN)、Ⅳ型胶原(CⅣ)水平与慢性乙型肝炎(CHB)肝纤维化严重程度的相关性及联合检测对疾病预后的预测价值。方法选取河南省中医院2021年3月至2022年3月收治的78例CHB肝纤维化患者作为研究组,选择同期78名健康体检者作为对照组。比较研究组和对照组及不同肝纤维化分期、不同炎症活动分级CHB肝纤维化患者入院时血清TGF-β1、Smad2、Smad3、HA、PCⅢ、LN、CⅣ水平;分析入院时血清TGF-β1、Smad2、Smad3、HA、PCⅢ、LN、CⅣ水平与肝纤维化分期、炎症活动分级的相关性。CHB肝纤维化患者治疗3个月后,根据患者预后分为预后良好和预后不良亚组,比较预后良好和预后不良患者入院时血清TGF-β1、Smad2、Smad3、HA、PCⅢ、LN、CⅣ水平;分析入院时血清TGF-β1、Smad2、Smad3、HA、PCⅢ、LN、CⅣ水平联合检测对CHB肝纤维化患者预后不良的预测价值。结果研究组入院时血清TGF-β1、Smad2、Smad3、HA、LN、PCⅢ、CⅣ高于对照组(P<0.05);不同肝纤维化分期、炎症活动分级CHB肝纤维化患者入院时血清TGF-β1、Smad2、Smad3、HA、LN、PCⅢ、CⅣ比较:S1<S2<S3<S4、G1<G2<G3<G4,差异有统计学意义(P<0.05);入院时血清TGF-β1、Smad2、Smad3、HA、LN、PCⅢ、CⅣ水平与肝纤维化分期、炎症活动分级均呈正相关(P<0.05)。预后良好患者入院时血清TGF-β1、Smad2、Smad3、HA、LN、PCⅢ、CⅣ水平均低于预后不良患者(P<0.05);入院时血清TGF-β1、Smad2、Smad3、HA、LN、PCⅢ、CⅣ水平联合预测肝纤维化患者预后不良的曲线下面积(AUC)优于各指标单一检测(P<0.05)。结论CHB肝纤维化患者入院时血清TGF-β1、Smad2、Smad3、HA、PCⅢ、LN、CⅣ水平均呈现高表达,且与肝纤维化分期、炎症活动分级密切相关,其联合检测对CHB肝纤维化患者预后有较高的预测价值,可用于评估CHB肝纤维化患者病情严重程度和预后,为制定针对性治疗措施提供参考。

HBV pgRNA联合HBcrAg对慢性乙型肝炎患者停药后复发的预测价值

目的分析乙型肝炎病毒(hepatitis B virus,HBV)前基因组RNA(pregenomic RNA,pgRNA)水平联合HBV核心相关抗原(hepatitis B virus core-related antigen,HBcrAg)定量对慢性乙型肝炎(chronic viral hepatitis B,CHB)患者停药后复发风险的预测价值。方法选取中国人民解放军联勤保障部队第926医院2020年6月至2021年6月收治的113例CHB患者为研究对象,所有患者均已给予足疗程的正规抗病毒治疗,停药前均检测批pgRNA与HBcrAg。根据患者停药1年内复发情况分为复发组(38例)和未复发组(70例),比较两组患者的一般资料、肝功能、肾功能、甲胎蛋白(alphafetoprotein,AFP)、pgRNA及HBcAg水平等指标。应用多因素Logistic回归分析CHB患者停药后复发的影响因素。应用受试者工作特征(receiver operator characteristic,ROC)曲线分析pgRNA联合HBcrAg对CHB患者停药后复发风险的预测价值。结果复发组患者饮酒史比例[47.37%(18/38)比22.86%(16/70)]、AFP[(29.64±7.18)μg/L比(20.38±6.46)μg/L]、pgRNA[(7.97±1.99)lg拷贝/ml比(4.97±1.24)lg拷贝/ml]和HBcrAg[(7.04±1.76)lg IU/ml比(5.11±1.28)lg IU/ml]水平均显著高于未复发组(P均<0.05)。多因素Logistic回归分析表明,饮酒史(OR=5.354,95%CI:1.055~68.858,P=0.046)、AFP(OR=1.189,95%CI:1.036~1.468,P=0.015)、pgRNA(OR=1.047,95%CI:1.117~8.109,P=0.007)和HBcrAg(OR=2.152,95%CI:1.154~4.308,P=0.021)是CHB患者停药后复发的独立危险因素。pgRNA与HBcrAg联合预测CHB患者停药后复发的ROC曲线下面积为0.954,最佳截点为>0.128,此时敏感度为98.9%,特异度为97.1%。结论pgRNA和HBcrAg与CHB患者停药后复发风险密切相关,早期监测两者水平有助于发现停药后复发高风险的患者,早期调整治疗方案。

妊娠合并慢性乙型肝炎血清HBV pgRNA、PreS1抗原表达与肝内胆汁淤积症的相关性分析

目的 探究妊娠合并慢性乙型肝炎病人血清乙型肝炎病毒(HBV)前基因组RNA(HBV pgRNA)、前S1抗原(PreS1Ag)水平变化及与妊娠期肝内胆汁淤积症(ICP)发生的相关性。方法 选取2017年6月至2020年6月在雅安市人民医院进行孕期检查的慢性乙型肝炎孕妇279例作为研究对象,根据入组病人是否患有ICP分为合并ICP组43例、未合并ICP组236例。比较两组病人血清中HBV pgRNA、PreS1 Ag水平,并分析两组血清HBV pgRNA、PreS1 Ag表达与HBV DNA表达水平相关性;比较两组病人妊娠结局,并分析合并ICP组病人血清HBV pgRNA表达水平及PreS1 Ag阳性表达率与妊娠结局的关系。受试者操作特征(ROC)曲线分析血清HBV pgRNA、PreS1 Ag光密度[D(λ)]值诊断慢性乙型肝炎孕妇合并ICP的效能。结果 合并ICP组慢性乙型肝炎病人血清HBV表面抗原(HbsAg)水平[(3.71±0.92)log IU/mL]、HBV e抗原(HbeAg)阳性率[65.12%(28/43)]、HBV DNA含量[(8.03±1.69)log copies/mL]、天冬氨酸转氨酶(AST)[(79.68±15.73)U/L]、丙氨酸转氨酶(ALT)[(72.08±16.95)U/L]、PreS1 Ag阳性表达率[88.37%(38/43)]、PreS1 Ag D(λ)值水平(1.24±0.25)及HBV pgRNA表达水平[(5.17±1.25)log copies/mL]明显高于未合并ICP组[(2.26±0.74)log IU/mL、24.15%(57/236)、(5.19±1.07)logcopies/mL、(23.01±12.47)U/L、(21.76±10.51)U/L、67.80%(160/236)、(0.92±0.23)、(3.02±0.98)logcopies/mL](P<0.05)。血清HBV pgRNA诊断慢性乙型肝炎孕妇合并ICP的曲线下面积(AUC)为0.89,灵敏度为81.40%,特异度为80.50%。PreS1 Ag D(λ)值诊断慢性乙型肝炎孕妇合并ICP的AUC为0.83,灵敏度为76.70%,特异度为79.20%。二者联合诊断的AUC为0.91,灵敏度为93.00%,特异度为78.40%。合并ICP组、未合并ICP组血清PreS1 Ag阳性的慢性乙型肝炎病人血清HBV DNA、HBV pgRNA表达水平均明显高于PreS1 Ag阴性表达病人(P<0.05)。合并ICP组、未合并ICP组血清HBV pgRNA、PreS1 Ag D(λ)值均与HBV DNA表达水平呈正相关(P<0.05)。合并ICP组产后出血、早产的发生率明显高于未合并ICP组(P<0.05)。发生不良妊娠结局的慢性乙型肝炎合并ICP病人血清PreS1 Ag阳性表达率、PreS1 Ag D(λ)值、HBV pgRNA表达水平均明显高于未发生不良妊娠结局病人(P<0.05)。结论 合并ICP的慢性乙型肝炎病人血清HBV pgRNA表达水平、PreS1 Ag阳性表达率及D(λ)值水平均明显升高,对ICP有一定诊断价值,且两者水平变化均与HBV DNA含量有关,并可能预示病人不良妊娠结局的发生。

血清壳多糖酶3样蛋白1和PLT的比值与FIB-4指数在慢性乙型肝炎轻、中度诊断效价的比较

目的比较血清壳多糖酶3样蛋白1(CHI3L1)和PLT的比值(CPR)与FIB-4指数在慢性乙型肝炎轻、中度的诊断效价。方法收集2023年1月至2023年12月在本院就诊的慢性乙型肝炎(CHB)轻、中度患者122例,其中CHB轻度患者30例(CHB轻度组),CHB中度患者92例(CHB中度组)。男78例,女44例;最小年龄12岁,最大年龄68岁,平均38.3±11.1岁。另外选取30例健康体检者为对照组,男16例,女14例;年龄27~57岁,平均41.6±9.8岁。要求被检者在清晨空腹抽血检测PLT、ALT、AST和CHI3L1,计算项目为CPR和FIB-4指数。计量资料符合正态分布采用LSD-t检验、非正态分布采用Mann-Whitney U检验;计数资料组间采用卡方检验。采用MedCalc统计绘制受试者工作特征(ROC)曲线及95%可信区(95%CI)。结果(1)3组中的年龄、CHI3L1、PLT、ALT、AST、FIB-4和CPR差异有统计学意义(U=3.288、10.837、8.627、7.130、8.225、4.485、12.966,P<0.01)。其中CHB中度组中的CHI3L1、ALT、CPR高于CHB轻度组和对照组(P<0.05),且CHB轻度组高于对照组(P<0.05);CHB中度组中的AST、FIB-4高于CHB轻度组和对照组(P<0.05);CHB中度组中的PLT低于轻度组和对照组(P<0.05);CHB中度组的年龄低于轻度组(P<0.05)。(2)CHB轻度组患者的CHI3L1的ROC曲线显示,CHI3L1的AUC=0.774(95%CI 0.645~0.903);FIB-4的AUC=0.551(95%CI 0.401~0.701);CPR的AUC=0.742(95%CI 0.608~0.876)。CHI3L1和CPR的灵敏度和特异性均优于FIB-4。CHI3L1与FIB-4独立诊断比较,差异有统计学意义(Z=2.246,P<0.05);CPR与FIB-4独立诊断比较,差异有统计学意义(Z=2.183,P<0.05)。(3)CHB中度患者的CHI3L1的ROC曲线显示,CHI3L1的AUC=0.793(95%CI 0.717~0.870);FIB-4的AUC=0.722(95%CI 0.629~0.814);CPR的AUC=0.832(95%CI 0.762~0.901)。CHI3L1和CPR的灵敏度和特异性均优于FIB-4。CPR与FIB-4独立诊断比较,差异有统计学意义(Z=2.244,P<0.05)。结论CPR在CHB轻度和中度患者的AUC明显高于同组中FIB-4,且CPR的升高趋势与临床表现严重程度一致,可作为临床评估CHB患者肝脏病程发展的无创检测指标。

慢性乙型肝炎者外周血SAA/CRP、NLR水平与HBV-DNA载量、病情程度的相关性分析

目的探究慢性乙型肝炎(chronic hepatitis B,CHB)患者外周血淀粉样蛋白A(serum amyloid A,SAA)与C反应蛋白(C-reactive protein,CRP)比值(SAA/CRP)、中性粒细胞与淋巴细胞比值(neutrophils lymphocytes ratio,NLR)水平与乙型肝炎病毒-脱氧核糖核酸(HBV-DNA)载量及病情程度的相关性。方法选取2020年6月至2022年6月达州市中西医结合医院100例CHB患者作为研究组,根据病情程度分为轻度(单纯CHB,n=36)、中度(乙肝代偿期肝硬化,n=33)和重度(乙肝失代偿期肝硬化,n=31)。另选同期、同年龄段50例健康志愿者作为对照组,比较研究组不同病情程度、对照组一般资料、血清SAA/CRP、NLR水平,并比较研究组不同HBV-DNA载量患者血清SAA/CRP、NLR水平,分析CHB患者血清SAA/CRP、NLR水平与HBV-DNA载量、病情程度的相关性;所有患者均行抗病毒治疗,治疗24周,比较不同抗病毒疗效患者治疗前、治疗后12周、24周血清SAA/CRP、NLR水平及变化值,分析治疗前后血清SAA/CRP、NLR水平变化值预测疗效的价值。结果重度CHB患者血清SAA/CRP、NLR水平>中度CHB患者>轻度CHB患者>健康人群(P<0.05);高载量患者血清SAA/CRP、NLR水平>中载量患者>轻载量患者(P<0.05);CHB患者血清SAA/CRP、NLR水平与HBV-DNA载量(r=0.756、0.709)、病情程度(r=0.776、0.745)呈正相关(P<0.05);无应答患者治疗后12周、24周外周血SAA/CRP、NLR水平均高于应答患者,变化值均低于应答患者(P<0.05);SAA/CRP△1、NLR△1单独预测的AUC分别为0.752、0.773,联合预测△1的AUC为0.861;SAA/CRP△2、NLR△2单独预测的AUC分别为0.796、0.819,联合预测△2的AUC为0.967,大于联合预测△1的AUC(P<0.05)。结论CHB患者的SAA/CRP、NLR与CHB HBV-DNA载量及病情程度具有相关性,临床可通过其水平变化评估病情及预测预后。

慢性乙型肝炎患者接受核(苷)酸类似物抗病毒治疗后血清HBV-DNA的表达及临床意义

目的探讨慢性乙型肝炎(CHB)患者接受核(苷)酸类似物(NAs)抗病毒治疗后血清乙型肝炎病毒脱氧核糖核酸(HBV-DNA)的表达及临床意义。方法回顾性分析2021年1月至2022年10月河南省人民医院83例采用NAs抗病毒治疗的CHB患者临床资料,根据血清学应答标准将其分为应答组(46例)和未应答组(37例)。比较两组基线资料、治疗前及治疗3、6、12个月时血清HBV-DNA水平;绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)检验血清HBV-DNA对CHB患者NAs抗病毒治疗未应答的预测价值。结果治疗前,应答组和未应答组HBV-DNA比较,差异无统计学意义(P>0.05);两组治疗前至治疗12个月的HBV-DNA呈下降趋势,组间、时点、交互效应有统计学意义(P<0.05)。绘制ROC曲线显示,治疗3个月时HBV-DNA对CHB患者NAs抗病毒治疗未应答的预测价值较低(AUC=0.694,P=0.002),治疗6个月时HBV-DNA对CHB患者NAs抗病毒治疗未应答具有一定预测价值(AUC=0.751,P<0.001)。结论血清HBV-DNA表达在CHB患者NAs抗病毒治疗前后变化明显,且治疗6个月时血清HBV-DNA可作为抗病毒治疗未应答的预测指标。