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Características histopatológicas y eficacia antiviral en pacientes mayores de 30 años con hepatitis B crónica en fase
Ke-Ying Ou1, Yue-Yang Ma1, Chuan-Su Yuan1
1Department of Infectious Disease and Liver Disease, the Second Hospital of Nanjing, Affiliated to Nanjing University of Chinese Medicine, Jiangsu, China.
Resumen
Más de la mitad de los pacientes con hepatitis B crónica HBeAg-negativa de más de 30 años en la fase indeterminada muestran inflamación hepática significativa o fibrosis. La terapia antiviral es efectiva, pero el monitoreo a largo plazo para el ADN del VHB, la viremia de bajo nivel y la resistencia a los medicamentos es crucial.
Área de la Ciencia:
- Hepatología Hepatología.
- Virología Virología.
- Gastroenterología y Gastroenterología.
Sus antecedentes:
- El manejo de la hepatitis B crónica (CHB) en la fase indeterminada sigue siendo controvertido.
- Los pacientes de CHB HBeAg-negativos mayores de 30 años requieren una consideración específica debido a los posibles cambios histopatológicos.
Objetivo del estudio:
- Investigar las características histopatológicas de los pacientes HBeAg-negativos con CHB de más de 30 años en la fase indeterminada.
- Para evaluar la eficacia antiviral en esta cohorte de pacientes.
Principales métodos:
- Estudio retrospectivo de los datos clínicos, de laboratorio e histopatológicos de 666 pacientes con CHB.
- Regresión logística y análisis de la curva ROC para identificar predictores de la inflamación del hígado y la fibrosis.
- Análisis de la eficacia del tratamiento antiviral en 62 pacientes.
Principales resultados:
- Más de la mitad de los 70 pacientes incluidos (edad media 40.5) tenían inflamación hepática significativa (30%) o fibrosis (55.7%).
- El recuento de glóbulos rojos (RBC) fue protector, mientras que el aspartato aminotransferasa (AST) predijo la inflamación y la fibrosis.
- El tratamiento antiviral logró >80% de conversión negativa del ADN del VHB a las 24 semanas, con un 6,5% experimentando viremia de bajo nivel (LLV) a las 48 semanas.
Conclusiones:
- La inflamación / fibrosis hepática significativa es común en pacientes con CHB HBeAg-negativos mayores de 30 años en la fase indeterminada.
- AST es un factor de riesgo, mientras que los glóbulos rojos son un factor protector para el daño hepático.
- La terapia antiviral es efectiva, pero requiere un monitoreo a largo plazo para el ADN del VHB, el LLV y la resistencia a los medicamentos.
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