Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
Department of Preventive Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
Liver Int. 2018 Oct;38(10):1751-1759. doi: 10.1111/liv.13705. Epub 2018 Mar 12.
The serum alanine aminotransferase (ALT) level has been used to identify at-risk patients with chronic hepatitis B (CHB) who need antiviral therapy. However, the level associated with increased liver-related mortality requiring active treatment is still unclear.
We used a Health Examination Cohort of the National Health Insurance Service of Korea that included approximately 0.5 million individuals aged 40-79 years. In total, 12 486 patients with CHB and no other concurrent liver disease were enrolled, and patients' liver-related mortality, including that owing to liver cancer, was investigated over 9 years.
The serum ALT level was correlated positively with liver-related mortality. The rates in men were 0.14, 0.17, 0.24, 0.57, 0.63 and 0.85 per 100 person-years (%) for serum ALT levels of <20, 20-29, 30-39, 40-49, 50-79 and ≥80 U/L, respectively, and the corresponding liver-related mortality rates in women were 0.03%, 0.09%, 0.12%, 0.63%, 0.65% and 0.32%. In patients with ALT levels of 40-79 U/L, the liver-related mortality rates were 0.60% in men and 0.64% in women, which were similar to the overall mortality rate of age- and sex-matched subjects without CHB (0.69%). The best cut-off values for liver-related mortality prediction were >34 U/L in men and >30 U/L in women.
The liver-related mortality rate increased significantly, even in CHB patients with relatively low serum ALT levels. Careful monitoring or earlier antiviral therapy should be considered for patients aged >40 years with serum ALT levels above the upper limit of normal.
血清丙氨酸氨基转移酶（ALT）水平已被用于识别需要抗病毒治疗的慢性乙型肝炎（CHB）高危患者。然而，与需要积极治疗的肝脏相关死亡率增加相关的水平仍不清楚。
我们使用了韩国国家健康保险服务的健康检查队列，该队列包括约 50 万名 40-79 岁的个体。总共纳入了 12486 名无其他合并肝脏疾病的 CHB 患者，并在 9 年内调查了患者的肝脏相关死亡率，包括因肝癌导致的死亡率。
血清 ALT 水平与肝脏相关死亡率呈正相关。男性的血清 ALT 水平<20、20-29、30-39、40-49、50-79 和≥80 U/L 的肝脏相关死亡率分别为 0.14、0.17、0.24、0.57、0.63 和 0.85 每 100 人年（%），女性分别为 0.03%、0.09%、0.12%、0.63%、0.65%和 0.32%。在 ALT 水平为 40-79 U/L 的患者中，男性的肝脏相关死亡率为 0.60%，女性为 0.64%，与无 CHB 的年龄和性别匹配的受试者的总死亡率（0.69%）相似。预测肝脏相关死亡率的最佳截断值为男性>34 U/L，女性>30 U/L。
即使在血清 ALT 水平相对较低的 CHB 患者中，肝脏相关死亡率也显著增加。对于血清 ALT 水平超过正常值上限的>40 岁患者，应考虑进行仔细监测或更早开始抗病毒治疗。
