Prognosis of acute-on-chronic liver failure caused by hepatitis recurrence after withdrawal of nucleos(t)ide analogues in chronic hepatitis B patients with different HBeAg status
10.3969/j.issn.1001-5256.2022.01.013
- VernacularTitle:不同HBeAg状态慢性乙型肝炎患者停用核苷(酸)类似物后肝炎复发致慢加急性肝衰竭的病情转归差异分析
- Author:
Jiacong SHEN
1
;
Xiaopeng LI
2
;
Xiaoyu CHENG
2
;
Yuanmei CHE
2
;
Wan LEI
3
;
Guanlin ZHOU
4
;
Lunli ZHANG
2
Author Information
1. Department of Infectious Diseases, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, China
2. Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Nanchang University, Key Laboratory of Liver Regeneration of Jiangxi Province, Nanchang 330006, China
3. Department of Science and Technology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
4. Department of Hepatology, Ganzhou Fifth People's Hospital, Ganzhou, Jiangxi 341099, China
- Publication Type:Original Articles_Viral Hepatitis
- Keywords:
Hepatitis B, Chronic;
Hepatitis B e Antigens;
Acute-On-Chronic Liver Failure;
Nucleosides;
Nucleotides
- From:
Journal of Clinical Hepatology
2022;38(1):86-90
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the difference in the prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) caused by hepatitis recurrence after withdrawal of nucleos(t)ide analogues (NUC) and possible causes in HBeAg-positive versus HBeAg-negative chronic hepatitis B (CHB) patients. Methods A total of 108 CHB patients with HBV-ACLF caused by withdrawal of NUC who were admitted to The First Affiliated Hospital of Nanchang University from January 2017 to December 2018 were enrolled, and according to HBeAg status, these patients were divided into HBeAg-positive group with 57 patients and HBeAg-negative group with 51 patients. The two groups were compared in terms of sex, age, clinical manifestation, signs, levels of total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase, prothrombin time, activated partial thromboplastin time, prothrombin time/international normalized ratio, and HBV DNA quantification on admission, complications (including hepatic encephalopathy, hepatorenal syndrome, and spontaneous bacterial peritonitis), and prognosis of HBV-ACLF. In addition, 48 CHB patients with continuous NUC antiviral therapy for > 2 years and HBV DNA < 20 IU/mL were enrolled, and the serum level of HBV pgRNA was measured to investigate the possible causes of the difference in the prognosis of HBV-ACLF between the patients with different HBeAg statuses. The two-independent-samples t test was used for comparison of normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data. Results For the 108 patients with HBV-ACLF caused by drug withdrawal and recurrence, the HBeAg-positive group had an improvement rate of 49.1% and the HBeAg-negative group had an improvement rate of 74.5%. The HBeAg-negative group had a significantly higher improvement rate than the HBeAg-positive group ( χ 2 =2.811, P =0.006). The HBeAg-positive group had a significantly higher level of HBV DNA than the HBeAg-negative group on admission ( t =-3.138, P =0.002). For the 48 CHB patients who achieved virologic response after long-term antiviral therapy, the HBeAg-positive group had a significantly higher HBV pgRNA load than the HBeAg-negative group ( H =2.814, P =0.049). Conclusion Compared with the HBeAg-positive CHB patients, HBeAg-negative CHB patients have a significantly better improvement rate of HBV-ACLF caused by hepatitis recurrence after withdrawal of NUC antiviral therapy. The difference in baseline HBV pgRNA level may be associated with the difference in the prognosis of HBV-ACLF in patients with different HBeAg statuses.
