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[Study on the natural history of chronic hepatitis B]
Guicheng Wu1, Weiping Zhou, Yourong Zhao
1Institute for Viral Hepatitis of Chongqing University of Medical Sciences, Chongqing 400010, China.
Insights
Chronic hepatitis B significantly increases the risk of liver cirrhosis, hepatocellular carcinoma, and death compared to the general population. Long-term outcomes for these patients are generally poor, highlighting the need for effective interventions.
Area of Science:
- Hepatology
- Virology
- Public Health
Context:
- Chronic hepatitis B (CHB) is a global health concern with significant long-term morbidity and mortality.
- Understanding the natural history and long-term outcomes of CHB is crucial for effective patient management and public health strategies.
Purpose:
- To elucidate the natural history of CHB.
- To evaluate the long-term therapeutic outcomes, antiviral efficacy, and economic impact of CHB.
- To identify prognostic factors influencing the progression of CHB.
Summary:
- A retrospective cohort study followed 183 CHB patients and 247 controls for over 11 years.
- CHB patients showed significantly higher rates of liver cirrhosis (12.02%), hepatocellular carcinoma (HCC) (6.56%), and death (10.93%) compared to controls.
- Mortality in CHB patients was 4.50 times higher than in the general population, with old age, severe histological injury, and male sex being major risk factors for death.
Impact:
- The findings underscore the poor long-term prognosis of CHB, emphasizing the need for improved treatment strategies and preventative measures.
- Identifying key risk factors for cirrhosis and death can aid in risk stratification and personalized patient care.
- This research contributes to a better understanding of the disease burden and economic significance of CHB.
Objective:
By clarifying the natural history of chronic hepatitis B, to evaluate its long-term therapeutic outcome, antiviral drugs efficacy and economic significance.
Methods:
A cohort of 183 (mean age of 31.75?.03 years, male/female ratio: 152:31) chronic hepatitis B patients with biopsy-proven and 247 cases of general population as control were followed up by retrospective cohort study. The follow-up time was 11.81?.08 years. This study was focused on long-term clinical outcome including the rate of liver cirrhosis, hepatocellular carcinoma and death, the long-term effect of antiviral drugs and prognostic factors.
Results:
In chronic hepatitis B patients, 22 (12.02%) developed liver cirrhosis, 12 (6.56%) hepatocellular carcinoma, and 20 (10.93%) died. The cumulative survival probabilities were 97.27%, 91.62%, and 84.47% in 5, 10, and 15 years, respectively. The cumulative probabilities of HCC were 0.00%, 3.19%, and 11.56% in 5, 10, and 15 years, respectively. In 247 control subjects, 6 (2.43%) died, none of them developed cirrhosis or HCC. The rates of death, liver cirrhosis, and HCC in hepatitis B patients were markedly different (P<0.005) compared with controls. The overall mortality of hepatitis B patients was 4.50 folds of the general population. Cox multiple regression analysis showed that old age, severe histological injury, and the positive HBeAg were closely related to liver cirrhosis, while old age, severe histological injury, and male were major factors leading to death. The independent variable of predicted HCC was not found.
Conclusions:
The long-term outcome of hepatitis B is poor.