The natural history of chronic hepatitis B: a retrospective study.
OBJECTIVE
To clarify the natural history of chronic hepatitis B so as to evaluate its long-term therapeutic outcome of the patients and the efficacy of antiviral drugs.


METHODS
A cohort of 183 biopsy-proven chronic hepatitis B patients (mean age of 31.75+/-8.03 years, male/female ratio: 152:31) and 247 controls were followed up retrospectively for 11.81+/-4.08 years. This study was focused on long-term clinical outcome including the rates of liver cirrhosis, hepatocellular carcinoma and death, apart from the long-term effect of antiviral drugs and prognostic factors.


RESULTS
In the 183 chronic hepatitis B patients, 22 (12.02%) developed liver cirrhosis, 12 (6.56%) developed hepatocellular carcinoma, and 20 (10.93%) died. The 5-, 10- and 15-year survival rates were 97.27%, 91.62%, and 84.47%, respectively. The 5-, 10- and 15-year incidence rates of HCC were 0, 3.19%, and 11.56%, respectively. In the 247 controls, 6 (2.43%) died; none of them developed cirrhosis or HCC. The rates of death, liver cirrhosis, and HCC in the hepatitis B patients were markedly different (P<0.005) compared with the controls. The overall mortality of hepatitis B patients was 4.5-fold higher than the general population. Cox multiple regression analysis showed that old age, severe histological injury, and positive HBeAg were closely related to liver cirrhosis; 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 patients is poor and the efficacy of antiviral drugs needs further study.
Wu
Gui-Cheng
GC
Department of Digestive Diseases, Chongqing Three Gorges Central Hospital, Wanzhou District, Chongqing 404000, China.
Zhou
Wei-Ping
WP
Zhao
You-Rong
YR
Guo
Shu-Hua
SH
Wang
Zhi-Yi
ZY
Zou
Shu-Bi
SB
Zhang
Quan-Hai
QH
Ren
Hong
H
Huang
Ai-Long
AL
Zhang
Ding-Feng
DF
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D019694:Hepatitis B, Chronic / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D008113:Liver Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D011336:Probability; D016016:Proportional Hazards Models; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D013997:Time Factors