Uto Hirofumi, Mawatari Seiich, Kumagai Kotaro, Ido Akio, Tsubouchi Hirohito
Department of Human and Environmental Sciences, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Hepat Mon. 2012 Feb;12(2):77-84. doi: 10.5812/hepatmon.829. Epub 2012 Feb 29.
Hepatitis C virus (HCV) infection causes chronic hepatitis, which frequently leads to hepatic fibrosis and hepatocellular carcinoma (HCC). Alanine aminotransferase (ALT) is a biomarker of hepatocyte injury and is associated with the progression of hepatic fibrosis. Advanced hepatic fibrosis also predisposes HCV carriers to a risk of HCC. In contrast, some cases with persistent HCV infection have normal ALT levels that persist for a long time, and these HCV carriers have no or mild hepatitis and hepatic fibrosis. These HCV carriers are defined as persistent normal ALT (PNALT) cases and their risk of HCC is low compared to HCV carriers with abnormal ALT. However, there are various definitions of normal ALT and PNALT, and advanced hepatic fibrosis may be missed without a liver biopsy. In addition, there is also a risk of ALT elevation in HCV carriers with PNALT, which increases the risk of progression to hepatic fibrosis and HCC. Most HCV carriers with PNALT have asymptomatic or nonspecific symptoms. HCV carriers with PNALT are also considered to be responsive to interferon-based treatment. Thus, assessment of hepatic fibrosis is important in HCV carriers, and the eradication of HCV infection is more likely in HCV carriers with evidence of hepatic fibrosis, regardless of their ALT levels.
丙型肝炎病毒（HCV）感染会导致慢性肝炎，常引发肝纤维化和肝细胞癌（HCC）。丙氨酸氨基转移酶（ALT）是肝细胞损伤的生物标志物，与肝纤维化的进展相关。晚期肝纤维化也使HCV携带者易患HCC。相比之下，一些持续感染HCV的病例ALT水平长期正常，这些HCV携带者无肝炎或仅有轻度肝炎及肝纤维化。这些HCV携带者被定义为持续正常ALT（PNALT）病例，与ALT异常的HCV携带者相比，他们患HCC的风险较低。然而，对于正常ALT和PNALT有多种定义，若不进行肝活检可能会漏诊晚期肝纤维化。此外，PNALT的HCV携带者也有ALT升高的风险，这会增加进展为肝纤维化和HCC的风险。大多数PNALT的HCV携带者无症状或仅有非特异性症状。PNALT的HCV携带者也被认为对基于干扰素的治疗有反应。因此，评估肝纤维化对HCV携带者很重要，无论ALT水平如何，有肝纤维化证据的HCV携带者更有可能根除HCV感染。
