Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
J Med Virol. 2010 Apr;82(4):539-45. doi: 10.1002/jmv.21686.
The importance of alanine aminotransferase (ALT) levels in the progression of hepatitis B virus (HBV) infection remains a subject of debate. This study sought to identify independent risk factors involved in development of hepatocellular carcinoma (HCC), particularly in patients with chronic HBV infection who have normal ALT values. Data from 381 consecutive hepatitis B patients were analyzed with average ALT integration values < or = 40 IU/L and follow-up periods of > 3 years. Integration values were calculated from biochemical tests, and serological markers associated with the cumulative incidence of HCC were analyzed. HCC developed in 17 of the 381 patients (4.5%) during the follow-up period. Male sex (hazard ratio, 6.011 [95% confidence interval: 1.353-26.710], P = 0.018), high HBV-DNA levels (> or = 5.0 log copies/ml; 5.125 [1.880-13.973], P = 0.001), low platelet counts (< 15.0 x 10(4)/mm(3); 4.803 [1.690-13.647], P = 0.003), and low total cholesterol levels (< 130 mg/dl; 5.983 [1.558-22.979], P = 0.009) were significantly associated with greater incidence of HCC development. High HBV-DNA levels and low platelet counts are associated with the development of HCC in patients infected with hepatitis B who have normal ALT values. Therefore, maintenance of low HBV-DNA levels is important for the prevention of HCC in patients with low platelet counts, particularly in patients whose ALT values fall within the current normal range.
丙型肝炎病毒 (HBV) 感染进展中丙氨酸氨基转移酶 (ALT) 水平的重要性仍然存在争议。本研究旨在确定与肝细胞癌 (HCC) 发展相关的独立危险因素，特别是在 ALT 值正常的慢性 HBV 感染患者中。对 381 例连续乙型肝炎患者进行了分析，平均 ALT 整合值 <或= 40 IU/L，随访时间> 3 年。整合值根据生化检测计算，分析了与 HCC 累积发生率相关的血清学标志物。在随访期间，381 例患者中有 17 例 (4.5%) 发展为 HCC。男性 (危险比，6.011 [95%置信区间：1.353-26.710]，P = 0.018)、高 HBV-DNA 水平 (>或= 5.0 log 拷贝/ml；5.125 [1.880-13.973]，P = 0.001)、血小板计数低 (< 15.0 x 10(4)/mm(3)；4.803 [1.690-13.647]，P = 0.003) 和总胆固醇水平低 (< 130 mg/dl；5.983 [1.558-22.979]，P = 0.009) 与 HCC 发展的发生率显著相关。在 ALT 值正常的乙型肝炎感染患者中，高 HBV-DNA 水平和低血小板计数与 HCC 的发生相关。因此，维持低 HBV-DNA 水平对于预防血小板计数低的患者发生 HCC 很重要，特别是在 ALT 值处于当前正常范围内的患者中。
