Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
J Viral Hepat. 2009 Dec;16(12):876-82. doi: 10.1111/j.1365-2893.2009.01145.x. Epub 2009 Jul 22.
Pretreatment alanine transaminase (ALT) elevation may be used as a predictor for higher hepatitis B e antigen (HBeAg) seroconversion in chronic hepatitis B patients. However, the role of dynamic changes of on-treatment ALT for seroconversion is unknown. A total of 170 naïve HBeAg-positive chronic hepatitis B patients were treated with a nucleoside/nucleotide analogues (NA), either lamivudine, adefovir, entecavir, or telbivudine, for at least 2 years and followed up for 1 more year. Clinical characteristics were detected and analysed at baseline and at 3-month intervals. On-treatment ALT predicted HBeAg seroconversion more accurately than baseline ALT. Among the patients with on-treatment ALT </=1 x UNL, 1-</=2 x UNL, 2-</=5 x UNL and >5 x UNL, HBeAg seroconversion was 11.4, 5.4, 24.4 and 65.0% (odds ratio = 1.0, 0.4, 2.5 and 14.4, respectively), respectively. Moreover, two models/types of seroconversion were observed. Type I was characterized by rapidly decreased ALT and HBV DNA during the first 3-month interval, but with high HBeAg reversion rate (50%) after consolidation treatment. Type II was a slow decreased DNA procedure accompanied by significant elevated ALT with less reversion (23%). Receiver operating characteristic curve analysis showed a 1.9-fold increased ALT ratio (present visit ALT: previous visit ALT) accompanied by at least a 0.8 log decreased HBV DNA may be used to classify these two seroconversion types. We conclude that on-treatment elevated ALT levels is a better predictor for seroconversion after NAs treatment, and HBV DNA profiles may help to identify different models of seroconversion.
治疗前丙氨酸氨基转移酶（ALT）升高可用作预测慢性乙型肝炎患者乙型肝炎 e 抗原（HBeAg）血清学转换的指标。然而，治疗过程中 ALT 的动态变化对血清学转换的作用尚不清楚。共有 170 例初治 HBeAg 阳性慢性乙型肝炎患者接受核苷（酸）类似物（NA）治疗，包括拉米夫定、阿德福韦酯、恩替卡韦或替比夫定，治疗至少 2 年，并随访 1 年以上。在基线和每 3 个月检测并分析临床特征。治疗过程中的 ALT 比基线 ALT 更能准确预测 HBeAg 血清学转换。在治疗过程中 ALT <=1 x 正常值上限（UNL）、1-<=2 x UNL、2-<=5 x UNL 和 >5 x UNL 的患者中，HBeAg 血清学转换率分别为 11.4%、5.4%、24.4%和 65.0%（比值比分别为 1.0、0.4、2.5 和 14.4）。此外，还观察到两种类型的血清学转换。I 型的特征是在最初的 3 个月间隔内 ALT 和 HBV DNA 迅速下降，但巩固治疗后 HBeAg 逆转率较高（50%）。II 型是 DNA 缓慢下降过程，同时伴有显著升高的 ALT，逆转率较低（23%）。受试者工作特征曲线分析显示，当前就诊 ALT 与前一次就诊 ALT 的比值增加 1.9 倍，HBV DNA 至少降低 0.8 log 可能用于对这两种血清学转换类型进行分类。我们的结论是，治疗过程中升高的 ALT 水平是 NA 治疗后血清学转换的更好预测指标，HBV DNA 谱有助于识别不同的血清学转换模式。
