未经治疗的慢性乙型肝炎合并脂肪肝患者的 ALT 水平：一项美国全国性研究。

ALT Levels in Treatment-Naive, Chronic Hepatitis B Patients with Concurrent Fatty Liver Disease: A US Nationwide Study.

机构信息

Department of Medicine, Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA.

Department of Medicine, California Pacific Medical Center, San Francisco, California, USA.

出版信息

Dig Dis. 2022;40(4):497-505. doi: 10.1159/000518645. Epub 2021 Jul 29.

DOI:10.1159/000518645

PMID:34348281

Abstract

INTRODUCTION

Treatment criteria for chronic hepatitis B (CHB) relies on ALT, which can be impacted by concurrent nonalcoholic fatty liver disease (NAFLD), but ALT data on patients with CHB and NAFLD are limited. We aimed to characterize ALT distribution in untreated CHB patients with NAFLD.

METHODS

We retrospectively analyzed untreated US adults with CHB (533 with NAFLD, 3,172 without NAFLD) using the Clinformatics™ Data Mart Database (2003-2019). The main outcome was ALT elevation (>1× upper limit of normal, 35/25 U/L for men/women, respectively). Secondary outcomes were advanced fibrosis (via FIB-4 index) and factors associated with fibrosis.

RESULTS

The majority of patients were Asian (61.0%) and hepatitis B e-antigen (HBeAg)-negative (90.4%). Patients with CHB and NAFLD were older (57.2 vs. 49.5 years, p < 0.001), more likely male (59.3% vs. 46.2%, p < 0.001), with higher percentages of advanced fibrosis (3.6% vs. 2.6%, p < 0.001) than those with CHB alone. CHB-NAFLD patients were more likely to have elevated ALT than those with CHB only, but this difference was only significant among those with low hepatitis B virus (HBV) DNA (38.1% vs. 25.6%, p < 0.001), not those with higher HBV DNA (>2,000 IU/mL). After adjusting for HBeAg, HBV DNA, and diabetes, NAFLD was not independently associated with advanced fibrosis (odds ratio 1.18, 95% confidence interval: 0.30-4.59, p = 0.81).

DISCUSSION

CHB-NAFLD patients with HBV DNA below treatment threshold were more likely to have elevated ALT but not those with higher HBV DNA, suggesting that ALT threshold does not need to be raised for antiviral eligibility for CHB with NAFLD.

摘要

简介

慢性乙型肝炎 (CHB) 的治疗标准依赖于 ALT，但 ALT 可能会受到非酒精性脂肪性肝病 (NAFLD) 的影响，而关于 CHB 和 NAFLD 患者的 ALT 数据有限。本研究旨在描述未经治疗的 CHB 合并 NAFLD 患者的 ALT 分布特征。

方法

我们回顾性分析了 Clinformatics™ Data Mart 数据库（2003-2019 年）中未经治疗的美国 CHB 成年患者（合并 NAFLD 者 533 例，无 NAFLD 者 3172 例）。主要结局是 ALT 升高（>1×正常值上限，男性/女性分别为 35/25 U/L）。次要结局是纤维化进展（通过 FIB-4 指数）和与纤维化相关的因素。

结果

大多数患者为亚洲人（61.0%）和 HBeAg 阴性（90.4%）。合并 NAFLD 的 CHB 患者年龄更大（57.2 岁 vs. 49.5 岁，p < 0.001），男性更多（59.3% vs. 46.2%，p < 0.001），纤维化进展比例更高（3.6% vs. 2.6%，p < 0.001）。与单纯 CHB 患者相比，CHB-NAFLD 患者的 ALT 升高更为常见，但这一差异仅在 HBV DNA 较低（<2,000 IU/mL）的患者中显著（38.1% vs. 25.6%，p < 0.001），而在 HBV DNA 较高（>2,000 IU/mL）的患者中不显著。在校正 HBeAg、HBV DNA 和糖尿病后，NAFLD 与纤维化进展无关（比值比 1.18，95%置信区间：0.30-4.59，p = 0.81）。