Objective: To analyze the clinical characteristics of HBV-related liver cirrhotic patients with low viral load. Methods: A retrospective analysis on 481 inpatients with HBV-related cirrhosis with low viral load [HBV DNA≤2 000 IU/ml (10(4) copies/ml)] general condition, virological indicators, liver function-related indicators, complications, and incidence of complications were analyzed. The t-test was used to compare the average measurement data, and the χ (2) test was used to compare the count data. Results: 481 cases were mainly male (male/female: 324/157), aged 20-83 (53.31 ± 11.67) years old. Han nationality accounted for 71.518%. 386 cases were HBsAg positive. 391 cases were HBeAg positive, and 140 cases were HBV DNA positive. The average value of bilirubin, albumin, alanine aminotransferase, aspartate aminotransferase, platelets, and prothrombin were 50.59 ± 91.25 (μmol/L), 33.68 ± 7.5 (g/L), and 60.66 ± 106.95(U/L), 63.37 ± 86.19(U/L), 106.65 ± 83.22(×10(9)/L), 68.82% ± 25.33%, respectively. CTP class A/B/C had 220/150/111 cases. The average values of CTP, MELD, APRI and FIB-4 were 7.61 ± 2.58, 10.98 ± 5.79, 2.34 ± 3.56, 6.91 ± 8.04, respectively. The overall incidence of complications in HBV-related cirrhotic patients with low viral load, HBV DNA negative, HBV DNA positive, HBsAg negative, and HBsAg positive were 80.0%, 82.7%, 73.6%, 85.3%, and 78.8%, respectively. Among them, 283 cases (58.84%), 197 cases (55.77%), 86 cases (61.43%), 52 cases (54.74%) and 231 cases (59.84%) were of hypersplenism, and 267 cases (55.51%), 197 cases (55.77%), 70 cases (50.00%), 56 cases (58.95%), and 211 cases (54.66%) were of esophagogastric varices. There were 59 cases (12.27%), 48 cases (14.08%), 11 cases (7.86%), 12 cases (12.63%), and 47 cases (12.18%) of rupture of esophageal and gastric varices, respectively. 202 cases (42.00%), 147 cases (43.11%), 55 cases (39.29%), 42 cases (44.21%), and 160 cases (41.45%) were of ascites, respectively. 17 cases (3.53%), 12 cases (3.52%), 5 cases (3.5%), 2 cases (2.11%), 15 (3.89%) cases were of hepatic encephalopathy, respectively. There were 6 cases (1.25%), 3 cases (0.88%), 3 cases (2.14%), 0 cases (0%), 6 cases (1.55%) of liver cancer. 29 cases (6.03%), 21 cases (6.16%), 8 cases (5.71%), 9 cases (9.47%) and 20 cases (5.18%) were of portal vein thrombosis. Compared with the overall incidence of complications, 341 HBV DNA-negative patients and 95 HBsAg-negative patients still had higher incidence of complications. The patients were grouped by age, and in < 40 years old, 40-50 years old, and > 50 years old, the overall complications were 80.8% in 42 cases, 76.8% in 116 cases and 81.7% in 227 cases, and the difference was not statistically significant. Conclusion: HBV infection patients with low viral load, and those whose HBsAg has disappeared, are still at risk of developing liver cirrhosis and even serious complications, and whether such population need antiviral therapy and benefit from it deserves further research.
目的： 分析低病毒载量HBV相关肝硬化患者临床特征。 方法： 回顾性分析481例低病毒载量[HBV DNA≤2 000 IU/ml（10(4)拷贝/ml）] HBV相关肝硬化住院患者一般情况、病毒学指标、肝功能相关指标、并发症、合并症发生情况。计量资料均数的比较采用t检验，计数资料的比较采用χ(2)检验。 结果： 481例患者男性为主（男/女为324/157),年龄20～83（53.31±11.67）岁,汉族占71.518%；386例HBsAg阳性，391例HBeAg阳性,140例HBV DNA阳性；总胆红素、白蛋白、丙氨酸转氨酶、天冬氨酸转氨酶、血小板、凝血酶原活动度分别为（50.59±91.25）μmol/L、（33.68±7.5）g/L、（60.66±106.95）U/L、（63.37±86.19）U/L、（106.65±83.22）×10(9)/L、68.82%±25.33%；CTP分级A/B/C级220/150/111例，CTP、MELD、APRI、FIB-4值分别为7.61±2.58、10.98±5.79、2.34±3.56、6.91±8.04。总体低病毒载量HBV相关肝硬化患者、HBV DNA阴性者、HBV DNA阳性者、HBsAg阴性者、HBsAg阳性者总体并发症发生率分别为80.0%、82.7%、73.6%、85.3%、78.8%；其中脾功能亢进分别有283例(58.84%)、197例（55.77%）、86例（61.43%）、52例（54.74%）、231例（59.84%），食管胃底静脉曲张分别有267例（55.51%）、197例（55.77%）、70例（50.00%）、56例（58.95%）、211例（54.66%），食管胃底静脉曲张破裂出血分别有59例(12.27%)、48例（14.08%）、11例（7.86%）、12例（12.63%）、47例（12.18%），腹水分别有202例(42.00%)、147例（43.11%）、55例（39.29%）、42例（44.21%）、160例（41.45%），肝性脑病分别有17例(3.53%)、12例（3.52%）、5例（3.57%）、2例（2.11%）、15例（3.89%），肝癌分别有6例(1.25%)、3例（0.88%）、3例（2.14%）、0例（0%）、6例（1.55%），门静脉血栓分别有29例（6.03%）、21例（6.16%）、8例（5.71%）、9例（9.47%）、20例（5.18%）。与总体并发症发生情况相比，341例HBV DNA阴性患者、95例HBsAg阴性患者仍具有较高的并发症发生率。对患者进行年龄分组，<40岁、40～50岁、>50岁总体并发症分别为42例（80.8%）、116例（76.8%）、227例（81.7%），差异无统计学意义。 结论： 低病毒载量HBV感染患者，甚至HBsAg已经消失的患者仍然具有发生肝硬化甚至严重并发症的风险，此类人群是否需要抗病毒治疗并从中获益值得进一步研究。.
Keywords: Cirrhosis; Clinical features; Hepatitis B virus; Low viral load.