Cross-sectional Retrospective Analysis Of Clinical Characteristics Of Chronic Hepatitis B Patients With NAs Treatment In Zhejiang Province

BackgroundHepatitis B virus(HBV)infection is one of the public health challenges that threatens the health of people around the world.China is considered to be a high-risk area for HBV infection,and about30 million patients with chronic hepatitis B(CHB)need antiviral treatment.After the popularization of hepatitis B vaccine,the HBV infection rate of children and adolescents has decreased significantly,but the aging of patients and the comorbidities have attracted attention.At present,CHB often needs long-term antiviral therapy of nucleoside/nucleotide analogs(NAs).During the treatment,kidney damage and drug resistance of NAs can be problematic.ObjectiveWe aimed to describe the clinical characteristics and comorbidities of CHB patients in Zhejiang Province,to study the risk factors of CHB with chronic kidney disease(CKD),and to provide a reference for the diagnosis and treatment of CHB patients.MethodsThis study was carried out in 5 centers in Zhejiang Province.The data were retrospectively extracted from the hospital medical charts,and the data were analyzed with SPSS 22.0 software.ResultsA total of 8,309 patients with CHB was enrolled in this study.The median age of the CHB patients was 46(37.00-55.00)years,15.56%(1293/8309)were over 60 years old,and the ratio of male to female was 2.08:1.The prevalence of diabetes mellitus,hypertension,and hepatic cirrhosis was respectively 3.49%,4.42%,and 23.72%.The prevalence of these comorbidities increased with age(P<0.001).Of the patients with CHB,5,332 had complete renal function results.Among them,patients with an estimated glomerular filtration rate of<60 m L/min/1.73m~2 accounted for 4.14%,and those with proteinuria for 8.33%.According to the definition of chronic kidney disease,the proportion of patients with chronic kidney disease was 11.37%.The prevalence of chronic kidney disease increased with age(P<0.001).Among patients with CKD,44.39%(269/606)had received antiviral therapy for more than 24 months,17.66%(107/606)had a history of lamivudine exposure,and 34.65%(210/606)had a history of nucleotide analogue exposure.In a multivariate analysis,age group(odds ratio[OR]=2.362),diabetes mellitus(OR=1.517),hypertension(OR=2.486),hepatic cirrhosis(OR=1.344),and nucleotide analogue exposure(OR=1.549)were significantly associated with CKD(P<0.05).In this study,only 651 CHB patients were examined for urinary microalbumin,the abnormal rate was 19.35%(126/651).ConclusionThe management of Chinese patients with CHB should take into consideration age,pre-existing mutations,and renal impairment.