临床肝胆病杂志2025，Vol.41Issue(6)：1056-1061,6.DOI:10.12449/JCH250609
调整抗病毒治疗方案对慢性乙型肝炎低病毒血症患者预后的影响
Influence of antiviral treatment adjustment on the prognosis of chronic hepatitis B patients with low-level viremia
摘要
Abstract
Objective To investigate the incidence rate of primary liver cancer(PLC)and the progression of liver fibrosis in chronic hepatitis B(CHB)patients with low-level viremia(LLV)(HBV DNA<2 000 IU/mL but≥20 IU/mL)after treatment adjustment,and to provide more robust evidence for clinical practice.Methods A retrospective analysis was performed for the clinical data of LLV patients who initially received nucleos(t)ide analogue(NAs)for at least 48 weeks at the Fifth Medical Center of PLA General Hospital from August 2007 to April 2017 and subsequently underwent NAs adjustment due to LLV,and according to the virologic response after 48 weeks of treatment adjustment,the patients were divided into LLV group and complete virological response(CVR)group(HBV DNA<20 IU/mL).The patients were followed up once every 3-6 months till the primary endpoint event of PLC or October 2024.The incidence rate of PLC and the progression of liver fibrosis were observed,and the progression of liver fibrosis was defined as an increase of≥1 grade in fibrosis-4(FIB-4)index.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups;the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to calculate the cumulative incidence rate of PLC,and the Log-rank test was used for comparison between groups;the Cox regression analysis was used to investigate the risk factors for PLC,and the Logistic regression analysis was used to investigate the influencing factors for the progression of liver fibrosis.Results A total of 307 patients were enrolled,with a mean age of 50.0 years,and the male patients accounted for 80.5%.After 48 weeks of treatment with the adjusted NAs regimen,254 patients(82.7%)achieved CVR,and 53 patients(17.3%)still had LLV.For the LLV group,the incidence rate of PLC was 30.2%and the rate of liver fibrosis progression was 22.6%,while for the CVR group,the incidence rate of PLC was only 13.4%,and the rate of liver fibrosis progression was 7.5%.The multivariate regression analyses showed that LLV was an independent risk factor for the onset of PLC(hazard ratio=2.623,95%confidence interval[CI]:1.315-5.234,P=0.006)and the progression of liver fibrosis(odds ratio=3.213,95%CI:1.385-7.455,P=0.007).Conclusion Active adjustment of treatment is needed immediately after the diagnosis of LLV to improve CVR,and if LLV persists after treatment adjustment,it is necessary to enhance the monitoring of liver fibrosis progression and PLC,so as to facilitate early diagnosis and treatment.关键词
乙型肝炎,慢性/低病毒血症/核苷(酸)类似物/肝肿瘤/肝纤维化Key words
Hepatitis B,Chronic/Low-level Viremia/Nucleos(t)ide Analogs/Liver Neoplasms/Liver Fibrosis引用本文复制引用
贺梦雯,杨武才,王春艳,付懿铭,郭畅,王建军,纪冬..调整抗病毒治疗方案对慢性乙型肝炎低病毒血症患者预后的影响[J].临床肝胆病杂志,2025,41(6):1056-1061,6.基金项目
国家自然科学基金面上项目(82470632) （82470632）
国家重点研发计划(2023YFC2306800) General Project of National Natural Science Foundation of China(82470632) （2023YFC2306800）
National Key Research and Development Program of China(2023YFC2306800) （2023YFC2306800）
