A Study On The Association Between The Presence Of Hepatitis B Core Antibody And Progression Of Liver Disease In Patient With Alcoholic Cirrhosis

Background and purpose: Our country has a high incidence of hepatitis B virus infection,as we know, the hepatitis B virus infection and alcohol can cause liver damage and accelerate liver failure in together. The patients with hepatitis B surface antigen(HBs Ag) negative and core antibody(anti-HBc) positive in serologic examination of HBV were more common in clinic. A large number of studies have confirmed that HBs Ag negative and anti-HBc positive are independent risk factors of the liver cirrhosis progressing to the primary liver cell cancer. The studies aimed at the relationship between anti-HBc and liver damage are rare. The purpose of this study is to research the relevance of anti-HBc positive and alcoholic liver cirrhosis.Methods: Retrospective analysis on the medical records from January 1, 2007 to December30, 2015 in the first hospital of lanzhou university, who was diagnosed with alcoholic liver cirrhosis. Participants were all male, repeatedly hospitalized patients were included in the first hospital information. Participants were both negative hepatitis B surface antigen(HBs Ag) with HCV antibody, eliminated the other causes of liver disease at the same time. To analyze and compare anti-HBc positive and negative groups in general, clinical manifestations, complications,the laboratory examination and the score of liver function, and according to the MELD score >11grouping on the degree of risk of patients with alcoholic liver cirrhosis and to evaluate the independent impact factors.Results: The 171 cases conformed to the standard of the medical records, there were 61(35.7%) persons which were anti-HBc positive(not taking into account the other HBV serological markers whether is positive), 110(64.3%) were anti HBc negative. Compared with the negative group, the symptoms of jaundice and abdominal distension have a higher rate in the Anti- HBc positive group(57.4% vs 36.4%,65.6% vs 50.9%),and was the most common symptom of anti-HBc group.The incidence of four complications(Hepatic encephalopathy, ascites, liver cancer,portal vein thrombosis) in anti- HBc positive group were higher than that of negative group,including portal vein thrombosis was the most significant(6.6% vs 2.7%), followed by hepaticencephalopathy(16.4% vs 9.1%).There were six indicators significantly increased in the anti-HBc positive compared with the negative groups, alanine aminotransferase(51.0 vs 34.5,P=0.000),the alkaline phosphatase(155.0 vs 133.5,P=0.039),the total bilirubin(5.4 vs 2.5,P=0.000), the direct bilirubin(44.5 vs 14.7,P=0.000)and the indirect bilirubin(45.0 vs 28.2,P=0.000)and the cholinesterase(2.9 vs 3.4,P=0.023) respectively. Calculate the score of liver function in two groups, Child-Pugh score(8.00 vs 7.00,P=0.007)、MELD score(6.20 vs 3.71,P=0.003)and MELE-Na score(5.08 vs-0.74,P=0.015)were higher in the anti-HBc positive group than those of the negative group. Logistic regression analysis found that anti-HBc positive( OR: 1.60;95%CI:1.32-4.02),ages from 45 to 65 years old(OR:5.26;95%CI:1.28-20.00),drinking amount was equal to or more than 150 g / day(OR:3.70;95%CI:1.47-9.09), drinking time was more than or equal to 25 years(OR:3.06;95%CI:1.07-8.72),jaundice(OR:6.41;95%CI:2.44-16.66)were the independent impact factors to the patients with severe alcoholic cirrhosis.Conclusion:1. when the HBs Ag negative, compared with anti-HBc negative patients, the clinical manifestation of jaundice, portal vein thrombosis, hepatic encephalopathy with anti-HBc positive is more obvious, and the laboratory index, such as alanine aminotransferas(ALT),the alkaline phosphatase(ALP), the total bilirubin(Tbil),direct bilirubin(Dbil), indirect bilirubin(Ibil) and cholinesterase(Ache)increase more obvious. So we should pay full attention to it in clinic.2.The HBs Ag negative and anti-HBc positive patients are usually associated with occult hepatitis B infection, it is recommended to detect the HBV-DNA in the liver or in the serum in order to confirm the cause.3 The abstinence to alcoholic is the best strategies in the treatment of alcoholic cirrhosis patients.4 For the pure alcoholic liver disease, it is recommended that the hepatitis B vaccine should be used as soon as possible to prevent HBV infection.