中国慢性乙型肝炎临床特征和抗病毒治疗模式十年变迁:基于CR-HepB的真实世界研究  

Ten-year changes in clinical characteristics and antiviral treatment patterns of chronic hepatitis B in China:a CR-HepB-based real-world study

作　　者：徐小倩 王皓 单姗[3] 尤红[3] 南月敏[4] 徐小元[5] 段钟平[6] 魏来 侯金林[8] 庄辉[9] 贾继东[3] 孔媛媛[1] 中国消除乙肝临床研究平台(CR-HepB)研究组 Xu Xiaoqian;Wang Hao;Shan Shan;You Hong;Nan Yuemin;Xu Xiaoyuan;Duan Zhongping;Wei Lai;Hou Jinlin;Zhuang Hui;Jia Jidong;Kong Yuanyuan;China Registry of Hepatitis B(CR-HepB)Group(Clinical Epidemiology and EBM Unit,Bejing Friendship Hospital,Capital Medical University,Bejing Clinical Research Institute,Beijing 100050,China;Beijing Clinical Research Institute,Beijing 100050,China;Liver Research Center,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing 100050,China;Department of Traditional and Western Medical Hepatology,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Infectious Diseases,Peking University First Hospital,Beijing 100034,China;Artificial Liver Center,Bejing You'an Hospital,Capital Medical University,Beijing 100069,China;Department of Hepatology,Beijing Tsinghua Changgung Hospital,Beijing 100044,China;Department of Infectious Diseases,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Microbiology and Parasitology,Peking University Health Science Center,Beijing 100191,China;不详)

机构地区：[1]首都医科大学附属北京友谊医院、北京市临床医学研究所临床流行病学与循证医学研究室,北京100050 [2]北京市临床医学研究所,北京100050 [3]首都医科大学附属北京友谊医院肝病中心,北京100050 [4]河北医科大学第三医院中西医结合肝病科,石家庄050051 [5]北京大学第一医院感染疾病科,北京100034 [6]首都医科大学附属北京佑安医院人工肝中心,北京100069 [7]北京清华长庚医院肝胆胰内科,北京100044 [8]南方医科大学南方医院感染内科,广州510515 [9]北京大学医学部病原生物学系,北京100191 [10]不详

出　　处：《中华肝脏病杂志》2023年第7期698-704,共7页Chinese Journal of Hepatology

基　　金：北京市卫生健康委员会高层次公共卫生技术人才项目(学科骨干-01-018);北京市属医院科研培育项目(PX2023005)。

摘　　要：目的了解我国慢性乙型肝炎(CHB)临床特征和抗病毒治疗模式十年变迁。方法提取中国消除乙型肝炎临床研究平台(CR-HepB)数据库中2012-2022年注册的慢性乙型肝炎病毒(HBV)感染者的人口学、病毒学、血液学、血生化及抗病毒治疗信息进行描述性统计和变化趋势分析。多组间比较采用Kruskal-Wallis H检验,计数资料组间比较采用χ^(2)检验。结果共纳入180012例慢性HBV感染者,中位年龄为40岁,男性占比为60.2%,HBeAg阳性率为43.3%。随时间推移,每年新增患者的中位年龄从39岁增高至47岁,HBeAg阳性率从51.3%下降至32.8%。患者初始诊断以CHB为主(71.4%),其次为乙型肝炎肝硬化(11.8%),非活动性HBsAg携带状态(10.6%)和慢性HBV携带状态(6.2%)。2012-2022每年新增注册患者中,乙型肝炎肝硬化占比保持稳定;2019年后CHB占比增加,其他诊断占比降低。在不同年龄组中,肝硬化患者比例随年龄增加,在<40、40~69、≥70岁年龄组分别为3.5%、19.3%和30.4%;肝硬化患者中女性比例也随年龄增加,由<30岁的16.1%增高至≥80岁的44.3%。2012-2022年,抗病毒治疗患者中一线核苷(酸)类似物使用比例逐年增高,由2012-2013年的51.0%增加至2022年的99.8%。结论CR-HepB注册数据反映了近十年,我国慢性HBV感染者临床特征及抗病毒治疗模式的变化,可为促进乙型肝炎诊疗实践和科学研究提供参考。Objective To understand ten-year changes in clinical characteristics and antiviral treatment patterns of chronic hepatitis B in China.Methods Patients with chronic HBV infection:demographic,virologic,hematologic,blood biochemistry,and antiviral treatment data were extracted from the China Registry of Hepatitis B(CR-HepB)database between 2012 and 2022 for descriptive statistics and change trend analysis.Multiple group comparisons were conducted using the Kruskal Wallis H test,while counting data was compared between groups usingχ^(2) test.Results A total of 180012 patients with chronic HBV infection were included,with a median age of 40 years old,and a male proportion accounting for 60.2%.The HBeAg positive rate was 43.3%.Over time,the median age of new patients each year increased from 39 to 47 years,while the HBeAg positive rate decreased from 51.3%to 32.8%.The initial diagnosis of patients was mainly CHB(71.4%),followed by hepatitis B cirrhosis(11.8%),inactive HBsAg carrier status(10.6%),and chronic HBV carrier status(6.2%).Among the newly registered patients every year from 2012 to 2022,the proportion of hepatitis B cirrhosis remained stable,but after 2019,the proportion of CHB increased and the proportion of other diagnoses decreased.The proportion of patients with cirrhosis increased with age in different age groups,with 3.5%,19.3%,and 30.4%in the<40,40-69,and≥70 age groups,respectively.The proportion of women in patients with cirrhosis also increased with age,from 16.1%in those<30 years old to 44.3%in those≥80 years old.From 2012 to 2022,the proportion of patients receiving first-line nucleos(t)ide analog antiviral treatment increased year by year,from 51.0%in 2012-2013 to 99.8%in 2022.Conclusion The CR-HepB registration data reflect the changes in clinical characteristics and antiviral treatment patterns in patients with chronic HBV infection in China over the past ten years and can thus provide a reference to promote hepatitis B diagnosis and treatment practice,as well as scientific research.

关 键 词：慢性乙型肝炎 肝硬化 诊疗模式 中国消除乙肝临床研究平台 CR-HepB 

分 类 号：R512.62[医药卫生—内科学]