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 in...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.展开更多
BACKGROUND Acute exacerbation in patients with chronic hepatitis B virus(HBV) infection results in different severities of liver injury. The risk factors related to progression to hepatic decompensation(HD) and acute-...BACKGROUND Acute exacerbation in patients with chronic hepatitis B virus(HBV) infection results in different severities of liver injury. The risk factors related to progression to hepatic decompensation(HD) and acute-on-chronic liver failure(ACLF) in patients with severe acute exacerbation(SAE) of chronic HBV infection remain unknown.AIM To identify risk factors related to progression to HD and ACLF in compensated patients with SAE of chronic HBV infection.METHODS The baseline characteristics of 164 patients with SAE of chronic HBV infection were retrospectively reviewed. Independent risk factors associated with progression to HD and ACLF were identified. The predictive values of our previously established prediction model in patients with acute exacerbation(AE model) and the model for end-stage liver disease(MELD) score in predicting the development of ACLF were evaluated.RESULTS Among 164 patients with SAE, 83(50.6%) had compensated liver cirrhosis(LC),43 had progression to HD without ACLF, and 29 had progression to ACLF within 28 d after admission. Independent risk factors associated with progression to HD were LC and low alanine aminotransferase. Independent risk factors for progression to ACLF were LC, high MELD score, high aspartate aminotransferase(AST) levels, and low prothrombin activity(PTA). The area under the receiver operating characteristic of the AE model [0.844, 95%confidence interval(CI): 0.779-0.896] was significantly higher than that of MELD score(0.690, 95%CI: 0.613-0.760, P < 0.05) in predicting the development of ACLF.CONCLUSION In patients with SAE of chronic HBV infection, LC is an independent risk factor for progression to both HD and ACLF. High MELD score, high AST, and low PTA are associated with progression to ACLF. The AE model is a better predictor of ACLF development in patients with SAE than MELD score.展开更多
目的观察慢性乙型肝炎(CHB)患者合并极轻肝脏脂肪变性的临床指标的变化,并分析极轻脂肪变性发生的相关影响因素。方法纳入2018年7月—2022年3月在南京大学医学院附属鼓楼医院感染疾病科行肝穿刺活检的CHB患者共179例。依据脂肪变性程度...目的观察慢性乙型肝炎(CHB)患者合并极轻肝脏脂肪变性的临床指标的变化,并分析极轻脂肪变性发生的相关影响因素。方法纳入2018年7月—2022年3月在南京大学医学院附属鼓楼医院感染疾病科行肝穿刺活检的CHB患者共179例。依据脂肪变性程度分为无脂肪变性组(n=98)、极轻脂肪变性组(n=81)。收集人口学信息、临床资料及肝组织病理学资料,比较各观察指标在两组中的差异。符合正态分布的计量资料两组间比较采用独立样本t检验,不符合正态分布的两组间比较采用Mann-Whitney U检验,计数资料两组间比较采用χ^(2)检验。相关性分析采用Spearman检验。Logistic回归分析极轻脂肪变性发生的危险因素。结果极轻脂肪变性组中男性比例(69.1%vs 52.0%)及显著纤维化比例(43.2%vs 25.5%)较无脂肪变性组高(χ^(2)值分别为5.390、6.234,P值均<0.05)。极轻脂肪变性组BMI[(23.61±2.95)kg/m^(2)vs(22.13±2.67)kg/m^(2)]、尿酸(UA)[333.0(291.0~375.5)μmol/L vs 287.5(244.8~345.3)μmol/L]、TG[0.92(0.66~1.14)μmol/L vs 0.77(0.62~1.02)μmol/L]、肝脏脂肪受控衰减参数(CAP)[234(214~258)dB/m vs 218(201~237)dB/m]水平均高于无脂肪变性组(t=-4.150,Z=-3.620,Z=-2.224,Z=-2.867,P值均<0.05)。正常体质量组,极轻脂肪变性患者UA[(333.0±63.9)μmol/L vs(291.0±72.8)μmol/L]、HBV DNA[4.44(3.51~6.79)log10IU/mL vs 3.42(3.00~5.03)log10IU/mL]高于无脂肪变性患者(t=-2.395,Z=-2.474,P值均<0.05)。BMI(OR=1.223,95%CI:1.086~1.378,P=0.001)、UA(OR=1.006,95%CI:1.002~1.010,P=0.008)为CHB合并极轻脂肪变性的危险因素。UA(OR=1.007,95%CI:1.001~1.013,P=0.022)为正常体质量CHB患者合并极轻脂肪变性的危险因素。结论合并极轻脂肪变性的CHB患者显著纤维化比例、CAP高于无脂肪变性者。BMI、UA是CHB患者发生极轻脂肪变性的独立危险因素。尤其在正常体质量CHB患者,UA升高与极轻脂肪变性的发生关系密切。展开更多
基金Supported by Construction of Key Medical Disciplines in Shenzhen,No.SZXK076.
文摘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.
基金Supported by the National Natural Science Foundation of China,No.81460124 and No.81860114
文摘BACKGROUND Acute exacerbation in patients with chronic hepatitis B virus(HBV) infection results in different severities of liver injury. The risk factors related to progression to hepatic decompensation(HD) and acute-on-chronic liver failure(ACLF) in patients with severe acute exacerbation(SAE) of chronic HBV infection remain unknown.AIM To identify risk factors related to progression to HD and ACLF in compensated patients with SAE of chronic HBV infection.METHODS The baseline characteristics of 164 patients with SAE of chronic HBV infection were retrospectively reviewed. Independent risk factors associated with progression to HD and ACLF were identified. The predictive values of our previously established prediction model in patients with acute exacerbation(AE model) and the model for end-stage liver disease(MELD) score in predicting the development of ACLF were evaluated.RESULTS Among 164 patients with SAE, 83(50.6%) had compensated liver cirrhosis(LC),43 had progression to HD without ACLF, and 29 had progression to ACLF within 28 d after admission. Independent risk factors associated with progression to HD were LC and low alanine aminotransferase. Independent risk factors for progression to ACLF were LC, high MELD score, high aspartate aminotransferase(AST) levels, and low prothrombin activity(PTA). The area under the receiver operating characteristic of the AE model [0.844, 95%confidence interval(CI): 0.779-0.896] was significantly higher than that of MELD score(0.690, 95%CI: 0.613-0.760, P < 0.05) in predicting the development of ACLF.CONCLUSION In patients with SAE of chronic HBV infection, LC is an independent risk factor for progression to both HD and ACLF. High MELD score, high AST, and low PTA are associated with progression to ACLF. The AE model is a better predictor of ACLF development in patients with SAE than MELD score.
文摘目的观察慢性乙型肝炎(CHB)患者合并极轻肝脏脂肪变性的临床指标的变化,并分析极轻脂肪变性发生的相关影响因素。方法纳入2018年7月—2022年3月在南京大学医学院附属鼓楼医院感染疾病科行肝穿刺活检的CHB患者共179例。依据脂肪变性程度分为无脂肪变性组(n=98)、极轻脂肪变性组(n=81)。收集人口学信息、临床资料及肝组织病理学资料,比较各观察指标在两组中的差异。符合正态分布的计量资料两组间比较采用独立样本t检验,不符合正态分布的两组间比较采用Mann-Whitney U检验,计数资料两组间比较采用χ^(2)检验。相关性分析采用Spearman检验。Logistic回归分析极轻脂肪变性发生的危险因素。结果极轻脂肪变性组中男性比例(69.1%vs 52.0%)及显著纤维化比例(43.2%vs 25.5%)较无脂肪变性组高(χ^(2)值分别为5.390、6.234,P值均<0.05)。极轻脂肪变性组BMI[(23.61±2.95)kg/m^(2)vs(22.13±2.67)kg/m^(2)]、尿酸(UA)[333.0(291.0~375.5)μmol/L vs 287.5(244.8~345.3)μmol/L]、TG[0.92(0.66~1.14)μmol/L vs 0.77(0.62~1.02)μmol/L]、肝脏脂肪受控衰减参数(CAP)[234(214~258)dB/m vs 218(201~237)dB/m]水平均高于无脂肪变性组(t=-4.150,Z=-3.620,Z=-2.224,Z=-2.867,P值均<0.05)。正常体质量组,极轻脂肪变性患者UA[(333.0±63.9)μmol/L vs(291.0±72.8)μmol/L]、HBV DNA[4.44(3.51~6.79)log10IU/mL vs 3.42(3.00~5.03)log10IU/mL]高于无脂肪变性患者(t=-2.395,Z=-2.474,P值均<0.05)。BMI(OR=1.223,95%CI:1.086~1.378,P=0.001)、UA(OR=1.006,95%CI:1.002~1.010,P=0.008)为CHB合并极轻脂肪变性的危险因素。UA(OR=1.007,95%CI:1.001~1.013,P=0.022)为正常体质量CHB患者合并极轻脂肪变性的危险因素。结论合并极轻脂肪变性的CHB患者显著纤维化比例、CAP高于无脂肪变性者。BMI、UA是CHB患者发生极轻脂肪变性的独立危险因素。尤其在正常体质量CHB患者,UA升高与极轻脂肪变性的发生关系密切。
