临床肝胆病杂志2025，Vol.41Issue(11)：2258-2264,7.DOI:10.12449/JCH251110
不确定期慢性HBV感染者发生显著肝组织病理学损伤的危险因素分析
High-risk factors for significant liver histopathological damage in patients with indeterminate phase of chronic HBV infection
摘要
Abstract
Objective To investigate the features of liver histopathological damage in patients with indeterminate phase of chronic HBV infection,as well as the timing for initiating antiviral therapy in such patients.Methods A retrospective screening was performed for the patients with chronic HBV infection who were hospitalized in The Fifth Medical Center of Chinese PLA General Hospital and underwent liver biopsy from March 2018 to April 2022,among whom the patients who met the criteria for indeterminate phase defined in Chinese guidelines for chronic hepatitis B prevention and treatment(2022 edition)were enrolled,and their clinical data were collected.Liver histopathological stage was determined using the Scheuer scoring system,with stages 0-4 for inflammation grade(G)and stages 0-4 for fibrosis degree(S),and the patients were divided into groups based on the presence of significant necroinflammation(≥G2)and significant liver fibrosis(≥S2).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 non-normally distributed continuous data between two groups;the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups.A Spearman's rank correlation analysis was used to investigate the correlation between liver histopathology and clinical factors,and the Logistic regression model was used to identify the independent influencing factors for significant necroinflammation and liver fibrosis.Results A total of 271 patients with indeterminate phase of chronic HBV infection were enrolled,among whom 61(22.5%)had significant necroinflammation(≥G2)and 124(45.8%)had significant liver fibrosis(≥S2).The Logistic regression analysis showed that alanine aminotransferase≥30 U/L(for male patients)or≥19 U/L(for female patients)(odds ratio[OR]=2.69,95%confidence interval[CI]:1.39-5.21,P=0.003),HBV DNA≥2 000 IU/mL(OR=2.75,95%CI:1.38-5.48,P=0.004),and liver stiffness measurement(LSM)≥6.0 kPa(OR=4.57,95%CI:2.17-9.62,P<0.001)were independent risk factors for significant inflammation.HBV DNA≥2 000 IU/mL(OR=1.82,95%CI:1.01-3.32,P=0.049)and LSM≥6.0 kPa(OR=2.06,95%CI:1.23-3.43,P=0.006)were independent influencing factors for significant liver fibrosis.Conclusion Among the patients with indeterminate phase of chronic HBV infection,a substantial proportion of patients have significant liver histopathological damage.Antiviral therapy should be initiated in a timely manner for patients with high-risk factors.关键词
乙型肝炎病毒/炎症/肝纤维化/不确定期Key words
Hepatitis B Virus/Inflammation/Hepatic Fibrosis/Indeterminate Phase引用本文复制引用
WANG Wenchang,LI Xuyang,WANG Chunyan,HE Mengwen,GUO Yifan,FU Yiming,LIU Miao,JI Dong..不确定期慢性HBV感染者发生显著肝组织病理学损伤的危险因素分析[J].临床肝胆病杂志,2025,41(11):2258-2264,7.基金项目
国家重点研发计划课题(2023YFC2306800) （2023YFC2306800）
国家自然科学基金(82470632) National Key Research and Development Program Project(2023YFC2306800) （82470632）
National Natural Science Foundation of China(82470632) （82470632）
