Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
PLoS One. 2016 Mar 11;11(3):e0142378. doi: 10.1371/journal.pone.0142378. eCollection 2016.
Patients with chronic hepatitic C (HCV) infection and normal serum alanine transaminase (ALT) levels were considered to have mild disease. In Taiwan, these patients were not suggested for interferon (IFN) based therapies. The aim of study is to compare therapeutic outcomes between HCV patients with normal and elevated ALT levels.
We conducted a retrospective study on 3241 HCV patients treated by IFN based therapies. Patients with normal ALT levels were classified as group A (n = 186) while those with elevated ALT levels were group B (n = 3055).
At baseline, incidence of diabetes mellitus, low platelet counts and cirrhosis were significantly higher in group B patients. The sustained virologic response (SVR) rate was comparable between the 2 groups (65.3% vs. 65.3%, P = .993). But significantly higher incidence of HCC development after HCV treatment was observed in group B (7.4% vs. 3.2%, P = .032). No significant differences with respect to the outcome of liver decompensation, spontaneous bacterial peritonitis, and mortality were noted between 2 groups. Multivariate analysis showed younger age, female gender, non-HCV genotype 1, lower viral load, higher platelet counts and non-cirrhosis were favorable factors for achieving SVR, rather than ALT levels. Further analysis revealed older age, cirrhosis, lower platelet levels and non- peg-interferon treatment are risk factors of HCC development.
HCV patients with normal ALT levels had similar response to antiviral therapy and low rate of HCC development after therapy. Antiviral therapies begun at early course of HCV infection may be beneficial to prevent disease progression.
慢性丙型肝炎（HCV）感染且血清丙氨酸转氨酶（ALT）水平正常的患者被认为疾病较轻。在台湾，这些患者不建议进行干扰素（IFN）治疗。本研究旨在比较 ALT 水平正常和升高的 HCV 患者的治疗结果。
我们对 3241 例接受 IFN 为基础治疗的 HCV 患者进行了回顾性研究。ALT 水平正常的患者分为 A 组（n = 186），ALT 水平升高的患者分为 B 组（n = 3055）。
基线时，B 组患者糖尿病、血小板计数低和肝硬化的发生率明显较高。两组患者的持续病毒学应答（SVR）率相当（65.3% vs. 65.3%，P =.993）。但 B 组 HCV 治疗后 HCC 发展的发生率明显较高（7.4% vs. 3.2%，P =.032）。两组间肝失代偿、自发性细菌性腹膜炎和死亡率的结果无显著差异。多变量分析显示，年龄较小、女性、非 HCV 基因型 1、病毒载量较低、血小板计数较高且无肝硬化是获得 SVR 的有利因素，而非 ALT 水平。进一步分析显示，年龄较大、肝硬化、血小板计数较低和未使用聚乙二醇干扰素治疗是 HCC 发展的危险因素。
ALT 水平正常的 HCV 患者对抗病毒治疗有相似的反应，且治疗后 HCC 发展的发生率较低。在 HCV 感染的早期开始抗病毒治疗可能有益于预防疾病进展。
