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The development of cirrhosis in patients with chronic type B hepatitis: a prospective study
1Liver Unit, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China.
Insights
Cirrhosis risk in chronic hepatitis B increases with age and severe liver damage. Factors like hepatic decompensation and viral reactivation significantly elevate cirrhosis development in these patients.
Area of Science:
- Hepatology
- Viral Hepatitis Research
Background:
- Chronic hepatitis B virus (HBV) infection is a global health concern.
- Cirrhosis is a major complication of chronic hepatitis B.
Purpose of the Study:
- To prospectively assess the incidence and contributing factors of cirrhosis in patients with chronic type B hepatitis.
- To identify risk factors associated with cirrhosis development in this population.
Main Methods:
- Prospective study of 684 clinicopathologically verified patients with chronic type B hepatitis.
- Follow-up period averaged 35.3 months, monitoring for cirrhosis development.
- Analysis of patient demographics, HBV e-antigen (HBeAg) status, and clinical events.
Main Results:
- Annual cirrhosis incidence was 2.4% in HBeAg-positive and 1.3% in anti-HBe-positive patients.
- Cirrhosis incidence significantly increased with age at study entry.
- Hepatic decompensation, severe acute exacerbations, and HBV reactivation (especially HBeAg reappearance) were strongly associated with higher cirrhosis rates (p < 0.001).
- Hepatitis delta virus superinfection and chronic active hepatitis did not increase cirrhosis risk.
Conclusions:
- Age is a significant factor in cirrhosis development in chronic hepatitis B.
- The extent, severity, duration, frequency, and etiology of hepatic lobular alterations are crucial in predicting cirrhosis.
- Specific clinical events, including viral reactivation, are key indicators for increased cirrhosis risk.
Abstract:
The incidence and contributing factors of cirrhosis developing in patients with chronic type B hepatitis were assessed prospectively in 684 clinicopathologically verified patients, of which 509 were HBeAg positive and 175 were anti-HBe positive at entry into the study. During an average follow-up period of 35.3 months, cirrhosis occurred 6 to 64 months after entry in 35 HBeAg-positive and 7 anti-HBe positive patients with a calculated annual incidence of 2.4 and 1.3%, respectively (p greater than 0.05). The incidence increased significantly with the increasing age at entry. Patients who had experienced (a) hepatic decompensation, (b) repeated episodes of severe acute exacerbation (with alpha-fetoprotein greater than 100 ng per ml and/or bridging hepatic necrosis), (c) severe acute exacerbation not accompanied by subsequent HBeAg seroconversion and (d) hepatitis B virus reactivation (particularly those with HBeAg reappearance) were found to develop cirrhosis much more frequently (p less than 0.001). Contrary to general belief, patients who had hepatitis delta virus superinfection and patients with chronic active hepatitis were not particularly prone to develop cirrhosis. We conclude that in addition to age factor, the extent, severity, duration, frequency and etiology of the hepatic lobular alterations are important factors for the development of cirrhosis in patients with chronic type B hepatitis.