Chen J, Xu C R, Xi M, Hu W W, Tang Z H, Zang G Q
Department of Infectious Disease, The Sixth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China.
Department of Infectious Disease, Southeast Hospital affiliated with Xiamen University, Zhangzhou, China.
J Viral Hepat. 2017 Jul;24(7):573-579. doi: 10.1111/jvh.12679. Epub 2017 Feb 16.
A proportion of chronic hepatitis B patients with normal or only minimally elevated alanine aminotransferase (ALT) levels display significant histologic changes and would benefit from antiviral therapy. We aim to evaluate the histologic abnormalities seen in these patients and then determine which of them would most likely respond to peginterferon therapy. One hundred and thirteen hepatitis B e antigen (HBeAg)-positive patients with a normal or minimally elevated ALT level and moderate-to-severe histologic changes in their liver tissue were selected to receive peginterferon monotherapy and participate in a follow-up analysis. A multiple logistic regression analysis indicated that increasing age (P=.049) and lower hepatitis B virus (HBV) DNA levels (P=.038) were associated with significant histological abnormalities in patients with a normal or minimally elevated ALT. Our predictive model which incorporated HBeAg testing at treatment week 12 combined with hepatitis B surface antigen (HBsAg) testing at treatment week 24 was able to identify which patients with a normal ALT level would achieve a sustained virological response (SVR) (positive predictive value [PPV]: 66.7%, negative predictive value [NPV]: 90.0%). Lower HBsAg and HBeAg levels at treatment week 24 were associated with a SVR in patients with a minimally elevated ALT level (PPV: 100.0%, NPV: 100.0%). A liver biopsy and antiviral therapy should be strongly considered when treating HBeAg-positive patients with a normal or minimally elevated ALT level, low HBV DNA level, and aged >35 years. On-treatment quantification of combined HBsAg and HBeAg test results may be useful for predicting a SVR to peginterferon monotherapy in these patients.
一部分丙氨酸氨基转移酶（ALT）水平正常或仅轻度升高的慢性乙型肝炎患者存在显著的组织学改变，且能从抗病毒治疗中获益。我们旨在评估这些患者的组织学异常情况，然后确定其中哪些患者最可能对聚乙二醇干扰素治疗有反应。选择113例乙型肝炎e抗原（HBeAg）阳性、ALT水平正常或轻度升高且肝组织有中度至重度组织学改变的患者接受聚乙二醇干扰素单药治疗并参与随访分析。多因素逻辑回归分析表明，年龄增加（P = 0.049）和乙型肝炎病毒（HBV）DNA水平降低（P = 0.038）与ALT正常或轻度升高患者的显著组织学异常相关。我们的预测模型纳入治疗第12周的HBeAg检测以及治疗第24周的乙型肝炎表面抗原（HBsAg）检测，能够识别哪些ALT水平正常的患者将实现持续病毒学应答（SVR）（阳性预测值[PPV]：66.7%，阴性预测值[NPV]：90.0%）。治疗第24周时较低的HBsAg和HBeAg水平与ALT轻度升高患者的SVR相关（PPV：100.0%，NPV：100.0%）。在治疗ALT水平正常或轻度升高、HBV DNA水平低且年龄>35岁的HBeAg阳性患者时，应强烈考虑进行肝活检和抗病毒治疗。治疗期间联合HBsAg和HBeAg检测结果的定量分析可能有助于预测这些患者对聚乙二醇干扰素单药治疗的SVR。
