Department of Infectious Diseases and Hepatology Unit, Panyu Central Hospital, Guangzhou, Guangdong, China.
Department of Hepatology, Huizhou Municipal Central Hospital, Huizhou, Guangdong, China.
Clin Exp Med. 2020 May;20(2):241-248. doi: 10.1007/s10238-019-00603-5. Epub 2020 Feb 12.
Alanine aminotransferase (ALT) levels between 1 and 2 times the upper limit of normal (ULN) are common in patients with chronic hepatitis B (CHB) infection. There are few clinical studies focused on this group of patients because of the poorer treatment outcomes compared to those with more than 2 × ULN ALT level. However, treatments are necessary to reduce liver damage for patients with minimally elevated ALT levels. And biomarkers are needed in predicting the treatment response. In this study, a total of 106 patients with CHB were enrolled and treated with entecavir, telbivudine or tenofovir disoproxil fumarate. Liver stiffness was measured by transient elastography, and quantitative levels of hepatitis B core antibody (HBcAb) were detected by ELISA. At week 96, 31 (29.25%) patients achieved hepatitis B e antigen (HBeAg) seroconversion. Notably, baseline HBcAb levels and liver stiffness measurements (LSM) were higher in patients who achieved HBeAg seroconversion. The multivariate analysis showed that the baseline HBcAb levels and LSM were independent predictors for HBeAg seroconversion. The area under receiver operating characteristic curve of baseline HBcAb, LSM and the combination of them for HBeAg seroconversion was 0.714, 0.720 and 0.717, respectively. In addition, we discovered that the patients with baseline HBcAb levels ≥ 4.15 log IU/mL and LSM ≥ 9.85 kPa had higher rates of HBeAg seroconversion. Therefore, the measurement of HBcAb and liver stiffness might be good approaches for the optimization of antiviral therapy for HBeAg-positive CHB patients with minimally elevated ALT levels.
丙氨酸氨基转移酶（ALT）水平在正常值上限（ULN）的 1 至 2 倍之间在慢性乙型肝炎（CHB）感染患者中很常见。由于与 ALT 水平超过 2×ULN 的患者相比，这些患者的治疗效果较差，因此针对这组患者的临床研究较少。然而，对于 ALT 水平轻度升高的患者，降低肝损伤是必要的，并且需要生物标志物来预测治疗反应。在这项研究中，共纳入 106 例 CHB 患者，给予恩替卡韦、替比夫定或替诺福韦酯治疗。通过瞬时弹性成像测量肝硬度，通过 ELISA 检测乙型肝炎核心抗体（HBcAb）的定量水平。在第 96 周时，31 例（29.25%）患者实现了乙型肝炎 e 抗原（HBeAg）血清学转换。值得注意的是，达到 HBeAg 血清学转换的患者的基线 HBcAb 水平和肝硬度测量值（LSM）更高。多变量分析显示，基线 HBcAb 水平和 LSM 是 HBeAg 血清学转换的独立预测因素。基线 HBcAb、LSM 及两者联合用于 HBeAg 血清学转换的受试者工作特征曲线下面积分别为 0.714、0.720 和 0.717。此外，我们发现基线 HBcAb 水平≥4.15 log IU/mL 和 LSM≥9.85 kPa 的患者 HBeAg 血清学转换率更高。因此，HBcAb 和肝硬度的测量可能是优化 ALT 水平轻度升高的 HBeAg 阳性 CHB 患者抗病毒治疗的良好方法。
