扩大慢性乙型肝炎抗病毒治疗应重视ALT正常、年龄≤30岁的HBeAg阴性慢性HBV感染者  

HBeAg-negative chronic HBV-infected individuals with normal alanine aminotransferase and an age of ≤30 years should be taken seriously when expanding anti-HBV treatment for chronic hepatitis B

作　　者：刘燕娜 李明蔚 王雷婕 赵鸿[3] 党双锁[4] 陈香梅[1] 赵景民 鲁凤民[1,6] LIU Yanna;LI Mingwei;WANG Leijie;ZHAO Hong;DANG Shuangsuo;CHEN Xiangmei;ZHAO Jingmin;LU Fengmin(Department of Microbiology and Infectious Disease Center,School of Basic Medical Sciences,Peking University,Beijing 100191,China;Department of Epidemiology and Biostatistics,College of Public Health,Zhengzhou University,Zhengzhou 450001,China;Department of Infectious Diseases,Peking University First Hospital,Beijing 100034,China;Department of Infectious Diseases,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;Department of Pathology and Hepatology,The Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China;Peking University Hepatology Institute,Peking University People’s Hospital,Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases,Beijing 100044,China)

机构地区：[1]北京大学基础医学院病原生物学系暨感染病研究中心,北京100191 [2]郑州大学公共卫生学院流行病学教研室,郑州450001 [3]北京大学第一医院感染疾病科,北京100034 [4]西安交通大学第二附属医院感染科,西安710004 [5]中国人民解放军总医院第五医学中心病理科,北京100039 [6]北京大学人民医院,北京大学肝病研究所,丙型肝炎和肝病免疫治疗北京市重点实验室,北京100044

出　　处：《临床肝胆病杂志》2022年第7期1477-1481,共5页Journal of Clinical Hepatology

基　　金：国家十三五“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项基金(2017ZX10302201)。

摘　　要：目的拟对2022年2月发布的《扩大慢性乙型肝炎抗病毒治疗的专家意见》的推荐意见进行分析验证和完善。方法本研究为单中心回顾性研究,连续纳入2014年1月—2020年10月于中国人民解放军总医院第五医学中心接受肝穿刺活组织病理检查且ALT正常的成人慢性HBV感染者,并分析≤30岁和>30岁亚组中不同HBeAg状态人群存在中、重度肝损伤人群比例。结果共纳入慢性HBV感染者290例,HBeAg阳性者121例(41.7%),HBeAg阴性者169例(58.3%)。进一步按年龄分组,在HBeAg阳性中,≤30岁37例,>30岁84例;在HBeAg阴性感染者中,≤30岁24例,>30岁145例。4组比较,年龄(H=151.539)、性别(χ^(2)=9.959)、ALT(H=29.041)、AST(H=11.127)、Alb(H=23.538)、HBV DNA(H=187.982)、HBsAg(H=132.520)组间比较差异均有统计学意义(P值均<0.05)。年龄>30岁和≤30岁组均有近50%的患者存在中度及以上肝损伤(50.22%vs 47.54%)。根据HBeAg状态和年龄进一步将患者分为HBeAg阳性≤30岁(n=37)和>30岁(n=84)以及HBeAg阴性≤30岁(n=24)和>30岁(n=145)共4组。在HBeAg阳性亚组中,>30岁与≤30岁者存在中度及以上肝损伤的差异无统计学意义(42.9%vs 37.8%,P=0.605);≤30岁的HBeAg阴性亚组与>30岁的HBeAg阴性亚组存在中度及以上肝损伤的差异亦无统计学意义(62.5%vs 54.5%,P=0.464)。在无创指标无法决策的队列(LSM<9.0 kPa者和LSM数据缺失但FIB-4<3.25者,n=269)中,≤30岁的HBeAg阴性亚组与>30岁的HBeAg阴性/阳性亚组存在中度及以上肝损伤的差异无统计学意义(59.1%vs 50.7%、59.1%vs 41.8%,P值分别为0.468、0.149)。结论在扩大抗HBV治疗时,也应关注HBeAg阴性且年龄≤30岁的慢性HBV感染者。条件允许时,依照本研究总结修订的抗病毒治疗启动线路图,或可进一步提高个体化抗病毒治疗的精准性。Objective To validate and refine the recommendations in the recently published expert opinion on expanding anti-HBV treatment for chronic hepatitis B.Methods Adult individuals with chronic HBV infection and normal alanine aminotransferase(ALT)who underwent liver biopsy in The Fifth Medical Center of Chinese PLA General Hospital from January 2014 to October 2020 were enrolled in this single-center retrospective study,and the proportion of individuals with moderate or severe liver injury was analyzed in the population with different HBeAg status in the≤30 years and>30 years subgroups.Results A total of 290 individuals with chronic HBV infection were included,among whom 121(41.7%)were HBeAg positive and 169(58.3%)were HBeAg negative.The HBeAg-positive group and the HBeAg-negative group were further divided into subgroups according to age:in the HBeAg-positive group,37 were aged≤30 years and 84 were aged>30 years;in the HBeAg-negative group,24 were aged≤30 years and 145 were aged>30 years.There were significant differences between the four groups in age(H=151.539,P<0.05),sex(χ^(2)=9.959,P<0.05),ALT(H=29.041,P<0.05),aspartate aminotransferase(H=11.127,P<0.05),albumin(H=23.538,P<0.05),HBV DNA(H=187.982,P<0.05),and HBsAg(H=132.520,P<0.05).In both>30 years and≤30 years groups,nearly 50%of the patients had a moderate or higher grade of liver injury(50.22%vs 47.54%).According to HBeAg status and age,the patients were further divided into HBeAg-positive≤30 years group with 37 patients,HBeAg-positive>30 years group with 84 patients,HBeAg-negative≤30 years group with 24 patients,and HBeAg-negative>30 years group with 145 patients.In the HBeAg-positive group,there was no significant difference in the proportion of patients with a moderate or higher grade of liver injury between the patients aged>30 years and those aged≤30 years(42.9%vs 37.8%,P=0.605),and there was also no significant difference in such proportion between the HBeAg-negative≤30 years group and the HBeAg-negative/positive>30 years groups(62.5%vs

关 键 词：乙型肝炎 慢性 肝炎e抗原 乙型 年龄因素 丙氨酸转氨酶 抗病毒治疗 

分 类 号：R512.62[医药卫生—内科学]