장기간의 추적관찰에 따른 만성 B형 간염의 자연경과

Abstract

Background/Aims: Chronic hepatitis type B is highly-prevalent in Korea. However, few studies about its natural history and prognostic factors have been presented until now. The natural course and long-term prognosis of chronic hepatitis type B varies greatly, and this diversity makes it difficu]t to predict the clinical course of individual patients. The histologic finding is known to be a important prognostic factor. Thus we conducted this study to evaluate the natural history and prognostic factors of chronic hepatitis type B in Korea. Methods: The authors analyzed the clinical courses of 147 patients with clinicopathologically proven chronic hepatitis type B through long-term follow-up from the time of the initial biopsy according to histologic classification. 15 patients had chronic persistent hepatitis(CPH). 61 patients had chronic active hepatitis without bridging necrosis(CAH-BN). 46 patients had chronic hepatitis with bridgung necrosis(CAH+BN). 25 patients had chronic active hepatitis with early cirrhotic change(CAH+LC). They were followed for 24 to 150 months(mean 70.8(+25.8)). Results: The probability of developing cirrhosis in chronic hepatitis type B was 0%, 2%, 10%, 18%, 23%, 28%, 37%, 49%, 54% in 1 year to 9 years, respectively. The 5-year cumulative probability of developing cirrhosis was 9% in CPH, 14% in CAH-BN, 22% in CAH+BN, and 55% in CAH+LC. The significant prognostic factors of developing cirrhosis were age(p<0.01) and histologic classification(p<0.001). The probability of developing decompensated cirrhosis in chronic hepatitis type B was 0%, 0%, 0%, 1%, 5%, 13%, 17%, 28%, and 32% in 1 year to 9 years, respectively. The probability of developing hepatocellular carcinoma(HCC) in chronic hepatitis type B was 0%, 0%, 0%, 1%, 3%, 3%, 6%, 8% and 8% in 1 year to 9 years, respectively. The significant prognostic factor of developing HCC was age. Conclusions: The results of this study explored the natural history and prognostic factors of chronic hepatitis type B. 5-year cumulative probability of developing cirrhosis, decompensated cirrhosis and HCC was 23%, 5% and 3%, respectively. Histologic classification and age were significant prognostic factors for the development of cirrhosis. Age was a significant prognostic factor for the development of HCC. (Korean J Gastroenterol 1997;29:343 - 351)