The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Clinical Characteristics of Occult HBV Infection and Impact on Treatment Response in Patients with Chronic Hepatitis C

만성 C형 간염에서 B형 간염바이러스 잠재감염의 임상양상과 C형 간염 치료에 미치는 영향

  • Byun, Sung Soo (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Shin, Jung Woo (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Ko, Myung Kwan (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Hong, Jung Min (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kim, Kyung Hoon (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Lee, Mu Yeol (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Choi, Hye-Jeong (Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Jeong, Yoong Ki (Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Park, Bo Ryung (Ulsan Biomedical Research Center, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Park, Neung Hwa (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
  • 변성수 (울산대학교 의과대학 울산대학교병원 내과) ;
  • 신정우 (울산대학교 의과대학 울산대학교병원 내과) ;
  • 고명관 (울산대학교 의과대학 울산대학교병원 내과) ;
  • 홍정민 (울산대학교 의과대학 울산대학교병원 내과) ;
  • 김경훈 (울산대학교 의과대학 울산대학교병원 내과) ;
  • 이무열 (울산대학교 의과대학 울산대학교병원 내과) ;
  • 최혜정 (울산대학교 의과대학 울산대학교병원 병리과) ;
  • 정융기 (울산대학교 의과대학 울산대학교병원 영상의학과) ;
  • 박보령 (울산대학교 의과대학 울산대학교병원 생의과학연구소) ;
  • 박능화 (울산대학교 의과대학 울산대학교병원 내과)
  • Published : 2012.12.01
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Abstract

Background/Aims: The prevalence of occult HBV infection (OBI) in patients with chronic hepatitis C (CHC) in Korea has not been reported. Additionally, it is unclear whether OBI influences treatment outcome in CHC patients. We investigated the prevalence of OBI and its impact on treatment outcome in patients with CHC. Methods: Seventy-six patients with CHC were enrolled and treated with pegylated or conventional interferon and ribavirin. Hepatitis B virus (HBV) DNA was detected by nested polymerase chain reaction. Results: Among the 68 patients who completed treatment and follow-up, HBV DNA was detected in serum from nine (13.2%) patients, liver tissue from 10 (14.7%), and serum or liver tissue from 15 (22.1%). OBI was diagnosed in nine (12.7%) control subjects. No difference in the prevalence of OBI between patients with CHC and controls was observed (13.2 vs. 12.0%; p = 0.92). No significant differences in age, sex, genotype 1 frequency, amount of hepatitis C virus RNA, anti-hepatitis B surface antigen/anti-hepatitis B core-IgG seropositivity, staging, or histology grading were observed in patients with or without HBV DNA. Sustained virological response was achieved in 73.3% of patients with OBI and 83.0% without OBI (p = 0.46). Conclusions: These results demonstrate that a significant proportion of patients with CHC have occult HBV infection and that OBI does not affect treatment outcome in patients with CHC.

목적: 만성 C형 간염 환자들은 HBV 잠재감염의 고위험군이며, HBV 잠재감염이 C형 간염 치료에 미치는 영향에 대한 상반된 결과들이 보고되어 있다. 본 연구는 만성 C형 간질환으로 항 바이러스 치료를 시행한 환자의 혈액과 조직에서 HBV 잠재감염의 임상양상과 잠재감염이 치료에 미치는 영향에 대해 알아보았다. 방법: 만성 C형 간질환자 68명이 대한 간학회 가이드라인에 따라(페길레이티드) 인터페론과 리바비린으로 치료하였다. 혈액 및 간조직에서 HBV DNA의 검출은 Pre-S/S, Pre-core/core, X 유전자에 특이적인 시발체를 Nested PCR 방법으로 검사하였다. 결과: 68명 중 혈청에서 9명(13.2%), 간 생검 조직에서 10명(14.7%), 혈청 또는 간 생검 조직에서 15명(22.1%)에서 B형 간염바이러스가 검출되었다. 대조군 중 9명(12.7%)의 혈청에서 B형 간염바이러스가 검출되어 만성 C형 간염 환자와 대조군에서 혈청 내 B형 간염바이러스 잠재감염률의 차이는 없었다(p = 0.92). HBV 잠재감염군(15명)과 비감염군(53명) 군간에 나이, 성별, 유전자 1형, 혈청 HCV RNA 양, Anti-HBc-IgG 양성, Anti-HBs 양성, 페길레이티드 인터페론 치료여부, 조직학적 소견에서 괴사 및 염증의 활성 정도(grade), 섬유화의 정도(stage)에 차이는 없었다. ALT는 잠재감염군에서 중앙값 106 IU/L (17-686)으로 비감염군 66 IU/L (18-844)에 비해 의미있게 높았다(p = 0.03). 치료가 종료된 68명 환자에서 RVR, EVR, ETR, SVR은 각각 61.8%, 94.1%, 95.6%, 80.9%였다. 치료실패는 치료 무반응이 3명, 재발이 10명으로 모두 유전자 1형 환자들이었다. HBV 잠재감염군에서 SVR은 73.3%로 비감염군의 66%와 통계학적 차이는 없었다. 결론: HBV 유병률이 높은 국내에서 만성 C형 간염 환자의 상당수에서 HBV 잠재감염을 확인할 수 있었으며, HBV 잠재감염이 만성 C형 간염 치료 결과에 영향을 미치지 않았다.

Keywords

References

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  1. Occult Hepatitis B Virus Infection in Patients with Chronic Hepatitis C: Innocent Bystander or Not? vol.83, pp.6, 2012, https://doi.org/10.3904/kjm.2012.83.6.728