Hoogland, P. (Petra) (2017) Levercirrose bij chronische hepatitis B: Is het risico daadwerkelijk te voorspellen met de HBV virale lading? thesis, Medicine.
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Abstract
Background: Multiple studies performed in Asian patients have shown that high serum levels of hepatitis B virus (HBV) DNA are associated with the development of cirrhosis of the liver. This is implemented in current guidelines in various parts of the world. However, it is unclear whether this also applies for non-Asian populations. Objective: Since solid confirmation in multi-ethnic populations lacks, in this study we tried to get information on the process of fibrosis in such a population. Primarily the association between HBV viral load and cirrhosis was investigated. Furthermore other possible risk factors for cirrhosis were evaluated. Methods: A cross-sectional study among patients with chronic HBV infection was performed in the Hepatitis Expertise Centre of Leeuwarden. Due to periodical measurement of the HBV viral load and serum levels of ALAT ([ALAT]), recent values of these parameters were available in the electronic patient system. Between August and December of 2016 patients were invited for a questionnaire and liver stiffness measurement (LSM) which was used to determine the fibrosis grade (F0-4). The association between fibrosis grade, viral load and other possible risk factors was analysed. Results: 63 patients with chronic HBV infection were included: 27/63 (42,9%) were of Asian origin. 20/63 (31,7%) had a viral load over 2000 IU/ml. HBV viral load was associated with higher fibrosis grade: 5/20 (25%) of patients with high viral load had F3-4 fibrosis, versus 2/43 (4,7%) of patients with lower viral load. Furthermore, [ALAT] above the upper limit of normal (ULN) was associated with higher fibrosis grade. A subgroup analysis showed that the association was mainly strong in patients with high viral load: 4/8 (50%) of patients with [ALAT] ≥ULN had F3-4 fibrosis, versus 1/12 (8,3%) of patients with [ALAT] <ULN. Notable was the fact that 4/12 (33,3%) of patients with high viral load had significant fibrosis or worse (≥F2) despite [ALAT] <ULN. Other factors associated with fibrosis grade were male sex and Diabetes Mellitus as a comorbidity. Conclusion: This study in a multi-ethnic population showed that HBV viral load was associated with fibrosis grade. A viral load over 2000 IU/ml appeared to be a good predictive factor for F3-4 fibrosis. The results weaken the hypothesis that high viral load is not associated with cirrhosis in all ethnicities. Current guidelines appear to be applicable in the Dutch multi-ethnic patient population. Furthermore, [ALAT] above the ULN appeared to be an important predictor of cirrhosis, especially in the case of high viral load. However, the finding that certain patients had developed significant fibrosis despite normal [ALAT], shows that a careful approach of these patients is needed, and that annual LSM has to be taken into consideration.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Wiersema, drs. U.S. and maag-darm-leverarts |
| Supervisor name: | Tweede begeleider: and Kampschreur, mw. dr. L.M. and internist-infectioloog and Afdeling Maag-darm-leverziekten/Infectiologie, Medisch Centr |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:41 |
| Last Modified: | 25 Jun 2020 10:41 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/232 |
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