慢性HBV感染者肝纤维化转归影响因素的队列研究  

A cohort study on factors influencing liver fibrosis progression in chronic HBV-infected patients

作　　者：王宝钰 李怡君 袁筱婕 张文华 张维璐 吉兆华 付婷 邵中军 WANG Baoyu;LI Yijun;YUAN Xiaojie;ZHANG Weilu;JI Zhaohua;FU Ting;ZHANG Wenhua;SHAO Zhongjun(School of Public Health,Gansu University of Chinese Medicine,Lanzhou,Gansu 730030,China;Department of Military Epidemiology and Epidemiology,Department of Military Preventive Medicine,the Fourth Military Medical University,Key Laboratory of Assessment and Prevention of Environmental Hazards in Special Operations of the Ministry of Education,Key Laboratory of Assessment and Protection against Environmental Health Hazards of Shaanxi Province,and Key Laboratory of Free Radical Biology and Medicine of Shaanxi Province,Xi'an,Shaanxi 710032,China;Education Department of Surgery,the First Affiliated Hospital,Air Force Military Medical University,Xi'an,Shaanxi 710032,China;Hepatobiliary Center,Wuwei Cancer Hospital,Wuwei,Gansu 733000,China)

机构地区：[1]甘肃中医药大学公共卫生学院,甘肃兰州730030 [2]空军军医大学军事预防医学系军队防疫与流行病学教研室,特殊作业环境危害评估与防治教育部重点实验室,陕西省环境健康危害评估与防护重点实验室,陕西省自由基生物学与医学重点实验室,陕西西安710032 [3]空军军医大学第一附属医院外科学教研室,陕西西安710032 [4]甘肃省武威肿瘤医院肝胆中心,甘肃武威733000

出　　处：《中国热带医学》2025年第3期270-275,共6页China Tropical Medicine

基　　金：国家自然科学基金青年项目(No.82404323);陕西省自然科学基础研究计划(No.2023-JC-QN-0987);陕西省重点研发计划项目(No.2024SF-YBXM-288)。

摘　　要：目的 监测甘肃省武威市慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者肝脏硬度动态变化与临床指标的相关性,为早期发现并有效干预肝纤维化(liver fibrosis,LF)进程提供科学依据。方法 基于武威乙肝专病队列,对3 882例慢性HBV感染者进行每年一次血清学及FibroScan超声检查,经过平均4年随访,监测LF转归情况并通过构建Logistic回归模型分析其影响因素。结果 在完成至少1次随访的2 053例慢性HBV感染者中,基线LF等级F0~F4分别有1 581例(77.0%)、164例(8.0%)、99例(4.8%)、110例(5.4%)和99例(4.8%),五组间年龄、性别、吸烟、抗病毒治疗、肝功指标、控制衰减指数(control attenuation index,CAP)、肝脏硬度值(liver stiffness measurement,LSM)差异有统计学意义(P<0.05)。经过平均4年随访,1 686例(17.9/100人年)LF等级无明显改变,260例(2.8/100人年)LF等级降低,107例(1.1/100人年)LF等级升高。按照基线治疗状态分组后,在未采取治疗的慢性HBV感染者中基线谷丙转氨酶(alanine aminotransferase,ALT)(OR=5.50,95%CI:1.79~16.83,P=0.003)和LSM(OR=3.35,95%CI:1.23~9.13,P=0.018)是LF进展的危险因素;而在抗病毒治疗的感染者中LF进展的危险因素则是基线谷草转氨酶(aspartate aminotransferase,AST)(OR=2.23,95%CI:1.41~3.53,P<0.001)和总胆红素(total bilirubin,TBIL)(OR=1.79,95%CI:1.14~2.81,P=0.012)水平。结论 LSM和肝功指标(ALT、AST和TBIL)是肝纤维化进展的重要影响因素,LSM和肝功指标的监测将对于肝硬化预防与早期诊断有重要意义。Objective To monitor the dynamic changes in liver stiffness and their correlation with clinical indicators among chronic hepatitis B virus(HBV)infected individuals in Wuwei City,Gansu Province,and to provide important evidence for the early detection and effective intervention of liver fibrosis(LF)progression.Methods Based on the Wuwei Hepatitis B Specialty Cohort,this study conducted annual serological and FibroScan ultrasonographic examinations for 3882 chronic HBVinfected individuals.Over an average of 4 years of follow-up,the liver fibrosis outcome was monitored,and influencing factors were analyzed by constructing a logistic regression model.Results Among the 2053 chronic HBV-infected individuals who completed at least one follow-up,baseline LF grades F0 to F4 were distributed as follows:1581 cases(77.0%),164 cases(8.0%),99 cases(4.8%),110 cases(5.4%),and 99 cases(4.8%),respectively.Significant differences were observed among the five groups in terms of age,gender,smoking,antiviral treatment,liver function indicators,control attenuation index(CAP),and liver stiffness measurement(LSM)(P<0.05).After an average of 4 years of follow-up,1686 cases(17.9/100 person-years)showed no significant change in LF grade, 260 cases (2.8/100 person-years) demonstrated a decrease in LF grade, and 107cases (1.1/100 person-years) exhibited an increase in LF grade. Stratified by baseline treatment status, among patients withchronic HBV infection who did not undergo treatment, baseline alanine aminotransferase (ALT) (OR=5.50, 95%CI:1.79-16.83,P=0.003) and LSM (OR=3.35, 95%CI:1.23-9.13, P=0.018) were identified as risk factors for LF progression. In contrast,among patients who underwent antiviral treatment, baseline aspartate aminotransferase (AST) (OR=2.23, 95%CI:1.41-3.53, P<0.001) and total bilirubin (TBIL) (OR=1.79, 95%CI:1.14-2.81, P=0.012) levels were identified as risk factors for LFprogression. Conclusion LSM and liver function indicators, such as ALT, AST, and TBIL, are important influencing factorsfor LF progression. The

关 键 词：乙型肝炎病毒 慢性感染者 肝脏硬度 肝纤维化 队列研究 

分 类 号：R512.6[医药卫生—内科学]