Nguyen K, Pan C, Xia V, Hu J, Hu K-Q
Division of GI/Hepatology, School of Medicine, University of California, Irvine, Orange, CA, USA.
Division of Gastroenterology and Hepatology, NYU Langone Medical Center, NYU School of Medicine, NewYork, NY, USA.
J Viral Hepat. 2015 Oct;22(10):809-16. doi: 10.1111/jvh.12388. Epub 2015 Jan 22.
The clinical course for chronic hepatitis B (CHB) patients with normal ALT and with or without minimal histologic activity remains unclear. We assessed frequency, amplitude, disease activities, and associated factors of ALT and/or AST flares in this subpopulation. Forty-seven consecutive treatment naïve Asian patients with CHB were enrolled from two liver clinics between December 2003 and January 2013, who had normal baseline ALT by routine clinical biochemical testing performed 6 weeks before or after the liver biopsy. We defined a flare as elevation of ALT/AST above the upper limit of normal of ALT/AST. The mean follow-up was 37.6 (CI = 12, 88) months, and the mean age at entry into the study was 43.3 (CI = 19, 65); 22/47 (46.8%) were males; 15/45 (33.3%), HBeAg+; 68.1% had stage 0-1 fibrosis; 63.8% had grade 0-1 inflammation. During follow-up, 13/47 (27.7%) cases developed ALT flare at least once in a mean of 13.5 (CI = 2, 43) months after liver biopsy; ALT flare was not associated with baseline ALT level, fibrosis stage, inflammation grade, hepatitis B virus (HBV) DNA load, HBeAg status, HBV genotype, HBV precore and basal core promoter mutations. 11/13 (84/6%) of ALT flares resolved during follow-up. 13/13 (100%) of ALT flares met AASLD treatment criteria, but only 6/13 (46.2%) were on HBV treatment. Serum ALT and/or AST flares occur frequently in CHB carriers who initially presented with normal ALT during pretreatment period. Thus, regular follow-up is warranted despite status of ALT/AST. No clinical factors were found to be associated with ALT flares.
谷丙转氨酶（ALT）正常且有或无轻微组织学活动的慢性乙型肝炎（CHB）患者的临床病程仍不明确。我们评估了该亚组患者中ALT和/或AST波动的频率、幅度、疾病活动度及相关因素。2003年12月至2013年1月期间，从两家肝病诊所连续纳入47例初治亚洲CHB患者，这些患者在肝活检前后6周进行的常规临床生化检测中基线ALT正常。我们将波动定义为ALT/AST升高超过ALT/AST正常上限。平均随访37.6（可信区间=12，88）个月，研究入组时的平均年龄为43.3（可信区间=19，65）岁；47例中有22例（46.8%）为男性；45例中有15例（33.3%）HBeAg阳性；68.1%有0-1期纤维化；63.8%有0-1级炎症。随访期间，47例中有13例（27.7%）在肝活检后平均13.5（可信区间=2，43）个月至少发生一次ALT波动；ALT波动与基线ALT水平、纤维化分期、炎症分级、乙型肝炎病毒（HBV）DNA载量、HBeAg状态、HBV基因型、HBV前核心和基本核心启动子突变无关。13例ALT波动中有11例（84.6%）在随访期间缓解。13例ALT波动均符合美国肝病研究学会（AASLD）治疗标准，但仅6例（46.2%）接受HBV治疗。血清ALT和/或AST波动在治疗前期ALT最初正常的CHB携带者中频繁发生。因此，无论ALT/AST状态如何，均需定期随访。未发现与ALT波动相关的临床因素。
