在慢性乙型肝炎病毒感染者的基于人群队列中，血清氨基转移酶水平升高的流行率和原因。
Prevalence and causes of elevated serum aminotransferase levels in a population-based cohort of persons with chronic hepatitis B virus infection.
机构信息
Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.
Arctic Investigations Program, Division of Preparedness and Emerging Infectious Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Anchorage, AK, United States.
出版信息
J Hepatol. 2014 Oct;61(4):785-91. doi: 10.1016/j.jhep.2014.05.045. Epub 2014 Jun 6.
BACKGROUND & AIMS: Information delineating the possible causes for elevated serum aminotransferase activity among persons with chronic hepatitis B virus (HBV) infection is limited.
METHODS
We analysed data collected from a population-based cohort of persons with chronic HBV infection followed from 2001 to 2010 to determine the frequency and causes of elevated aminotransferase activity. Any elevation concurrent with an HBV DNA level ⩾2000 IU/ml was attributed to immune active hepatitis B. Participant medical charts were reviewed by expert clinical staff to determine the presence of additional or alternative attributable causes. For each participant, a serum aminotransferase elevation could be attributed to more than one cause.
RESULTS
Among 1090 persons with chronic HBV infection, the mean follow-up was 7.7 years and the median age in 2001 was 39 (range 19-96) years; 634 (58.2%) had ⩾1 elevated aminotransferase level during follow-up and 438 (69.1%) of persons with ⩾1 elevation had at least one cause assigned for the elevation. The most common causes of aminotransferase elevations were immune active hepatitis B (48.4%), alcohol consumption (30.8%), and non-alcoholic fatty liver disease (NAFLD) (24.7%). Among participants with HBV DNA levels persistently less than 2000 IU/ml, the most common causes were NAFLD or alcohol consumption.
CONCLUSIONS
In this population-based cohort of persons with chronic HBV infection, the prevalence of elevated aminotransferase activity was high and attributable to immune active chronic hepatitis B in approximately half of the cases; however, NAFLD or alcohol consumption were also common causes for enzyme elevations. These findings underscore the importance of monitoring HBV DNA levels, in addition to aminotransferase activity, among persons with chronic HBV infection so that appropriate interventions, including antiviral therapy, are utilised.
背景与目的
有关慢性乙型肝炎病毒（HBV）感染者血清氨基转移酶活性升高的可能原因的信息有限。
方法
我们分析了 2001 年至 2010 年期间对慢性 HBV 感染者进行的基于人群的队列研究的数据，以确定氨基转移酶活性升高的频率和原因。任何与 HBV DNA 水平 ⩾2000IU/ml 同时升高的情况均归因于免疫活性乙型肝炎。由专家临床工作人员审查参与者的病历，以确定是否存在其他或替代的可归因原因。对于每个参与者，血清氨基转移酶升高可能归因于多种原因。
结果
在 1090 名慢性 HBV 感染者中，平均随访时间为 7.7 年，2001 年的中位年龄为 39 岁（范围 19-96 岁）；随访期间有 634 名（58.2%）至少有 1 次氨基转移酶水平升高，其中 438 名（69.1%）升高者至少有 1 种升高原因。氨基转移酶升高最常见的原因是免疫活性乙型肝炎（48.4%）、酒精摄入（30.8%）和非酒精性脂肪性肝病（NAFLD）（24.7%）。在 HBV DNA 水平持续低于 2000IU/ml 的参与者中，最常见的原因是 NAFLD 或酒精摄入。
结论
在本项基于人群的慢性 HBV 感染者队列研究中，氨基转移酶活性升高的患病率较高，其中约一半病例归因于免疫活性慢性乙型肝炎；然而，NAFLD 或酒精摄入也是酶升高的常见原因。这些发现强调了监测慢性 HBV 感染者的 HBV DNA 水平以及氨基转移酶活性的重要性，以便利用包括抗病毒治疗在内的适当干预措施。
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