Lin Chih-Lin, Liao Li-Ying, Liu Chun-Jen, Yu Ming-Whei, Chen Pei-Jer, Lai Ming-Yang, Chen Ding-Shinn, Kao Jia-Horng
Department of Gastroenterology, Ren-Ai branch, Taipei City Hospital, and Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan.
Hepatology. 2007 May;45(5):1193-8. doi: 10.1002/hep.21585.
Chronic hepatitis B patients with high-normal serum ALT (levels of 0.5-1x upper limit of normal) are still at risk of liver disease progression. We thus investigated the correlation between serum ALT level and hepatitis B viral factors in HBeAg-negative carriers with persistently normal serum ALT level (PNALT). Baseline clinical and virological features of 414 HBeAg-negative carriers, including 176 (42.5%) with low-normal ALT (levels of less than 0.5x upper limit of normal) and 238 (57.5%) with high-normal ALT, were compared. Compared with HBV carriers with low-normal ALT, those with high-normal ALT were older (41 vs. 37 years, P<0.001) and had a greater frequency of serum HBV DNA level>10(4) copies/ml (63.4% vs. 47.5%, P<0.001) as well as a higher prevalence of basal core promoter T1762/A1764 mutant (36.5% vs. 24.2%, P=0.01). Multivariate analysis showed that factors associated with a high-normal serum ALT level included male sex [odds ratio (OR), 1.82; 95% confidence interval (CI), 1.10-3.01, P=0.019], increasing age (OR, <30 years: 1, reference; 30-39 years: 2.43, 95% CI, 1.18-5.03, P=0.016; 40-49 years: 4.22, 95% CI, 1.99-8.93, P<0.001; >or=50 years: 4.06, 95% CI, 1.69-9.78, P=0.002) and serum HBV DNA level>10(4) copies/ml (OR, 1.83; 95% CI, 1.07-3.13, P=0.027).
HBeAg-negative patients with persistently normal ALT are not a homogenous group, and those with high-normal ALT share some of the characteristics that have been associated with adverse long-term outcomes.
血清ALT处于高正常范围（水平为正常上限的0.5 - 1倍）的慢性乙型肝炎患者仍有肝病进展风险。因此，我们研究了血清ALT水平与血清ALT持续正常（PNALT）的HBeAg阴性携带者中乙肝病毒因素之间的相关性。比较了414例HBeAg阴性携带者的基线临床和病毒学特征，其中176例（42.5%）ALT处于低正常范围（水平低于正常上限的0.5倍），238例（57.5%）ALT处于高正常范围。与ALT处于低正常范围的HBV携带者相比，ALT处于高正常范围的患者年龄更大（41岁对37岁，P<0.001），血清HBV DNA水平>10⁴拷贝/ml的频率更高（63.4%对47.5%，P<0.001），基础核心启动子T1762/A1764突变的患病率也更高（36.5%对24.2%，P = 0.01）。多因素分析显示，与血清ALT高正常水平相关的因素包括男性[比值比（OR），1.82；95%置信区间（CI），1.10 - 3.01，P = 0.019]、年龄增加（OR，<30岁：1，参照；30 - 39岁：2.43，95% CI，1.18 - 5.03，P = 0.016；40 - 49岁：4.22，95% CI，1.99 - 8.93，P<0.001；≥50岁：4.06，95% CI，1.69 - 9.78，P = 0.002）以及血清HBV DNA水平>10⁴拷贝/ml（OR，1.83；95% CI，1.07 - 3.13，P = 0.027）。
ALT持续正常的HBeAg阴性患者并非同质群体，ALT处于高正常范围的患者具有一些与不良长期结局相关的特征。
