对于乙肝e抗原阴性慢性乙型肝炎病毒感染的治疗决策而言，是否存在有意义的血清乙肝病毒DNA临界值水平？
Is there a meaningful serum hepatitis B virus DNA cutoff level for therapeutic decisions in hepatitis B e antigen-negative chronic hepatitis B virus infection?
作者信息
Papatheodoridis George V, Manesis Emanuel K, Manolakopoulos Spilios, Elefsiniotis Ioannis S, Goulis John, Giannousis John, Bilalis Antonios, Kafiri Georgia, Tzourmakliotis Dimitrios, Archimandritis Athanasios J
机构信息
2nd Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital of Athens, Athens, Greece.
出版信息
Hepatology. 2008 Nov;48(5):1451-9. doi: 10.1002/hep.22518.
UNLABELLED
The diagnosis of hepatitis B e antigen (HBeAg)-negative chronic hepatitis B indicating therapeutic intervention currently requires serum hepatitis B virus (HBV) DNA >or=2,000 IU/mL. We evaluated the severity of liver histology and the presence of histological indication for treatment in patients with HBeAg-negative chronic HBV infection focusing on those with low viremia and/or normal alanine aminotransferase (ALT). In total, 399 patients with increased ALT and detectable serum HBV DNA (chronic hepatitis B patients) and 35 cases with persistently normal ALT and HBV DNA >2,000 IU/mL (inactive carriers) were included. Histological indication for treatment (grading score >or=7 and/or stage >or=2 in Ishak's classification) was found in 91% (185/203), 82% (75/91), 75% (47/63), and 62% (26/42) of chronic hepatitis B patients with HBV DNA >or=200,000, 20,000-199,999, 2,000-19,999, and <2,000 IU/mL, respectively (P < 0.001). Histological indication for treatment was more frequent in chronic hepatitis B patients with persistently elevated ALT (86% or 275/321), but it was also found in 74% (58/78) of those with transiently normal ALT (P = 0.025). All inactive carriers had HBV DNA <20,000 IU/mL. Histological indication for treatment was present in 17% (6/35) of inactive carriers always due to moderate (stage 2) fibrosis without active necroinflammation.
CONCLUSION
HBeAg-negative chronic HBV patients with persistently or transiently increased ALT and HBV DNA >or=20,000 IU/mL almost always require therapeutic intervention, but histological indications for treatment are also present in the majority of such cases with HBV DNA <20,000 and even <2,000 IU/mL. In contrast, minimal histological lesions are observed in the majority of HBeAg-negative patients with persistently normal ALT and HBV DNA >2,000 IU/mL, who may not require immediate liver biopsy and treatment but only close follow-up.
未标记
目前，对于乙型肝炎e抗原（HBeAg）阴性慢性乙型肝炎的诊断以确定是否需要进行治疗干预，要求血清乙型肝炎病毒（HBV）DNA≥2000 IU/mL。我们评估了HBeAg阴性慢性HBV感染患者的肝脏组织学严重程度以及存在的组织学治疗指征，重点关注病毒血症水平低和/或丙氨酸氨基转移酶（ALT）正常的患者。总共纳入了399例ALT升高且血清HBV DNA可检测到的患者（慢性乙型肝炎患者）以及35例ALT持续正常且HBV DNA>2000 IU/mL的患者（非活动性携带者）。在HBV DNA≥200000、20000 - 199999、2000 - 19999以及<2000 IU/mL的慢性乙型肝炎患者中，分别有91%（185/203）、82%（75/91）、75%（47/63）和62%（26/42）存在组织学治疗指征（Ishak分类中分级评分≥7和/或分期≥2）（P<0.001）。ALT持续升高的慢性乙型肝炎患者中组织学治疗指征更常见（86%或275/321），但在ALT短暂正常的患者中也有74%（58/78）存在该指征（P = 0.025）。所有非活动性携带者的HBV DNA<20000 IU/mL。17%（6/35）的非活动性携带者存在组织学治疗指征，均是由于中度（2期）纤维化且无活动性坏死性炎症。
结论
ALT持续或短暂升高且HBV DNA≥20000 IU/mL的HBeAg阴性慢性HBV患者几乎总是需要治疗干预，但在HBV DNA<20000甚至<2000 IU/mL的大多数此类病例中也存在组织学治疗指征。相比之下，在大多数ALT持续正常且HBV DNA>2000 IU/mL的HBeAg阴性患者中观察到最小的组织学病变，这些患者可能不需要立即进行肝活检和治疗，仅需密切随访。
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