抗病毒治疗对 HBeAg 阴性慢性乙型肝炎患者中丙氨酸氨基转移酶正常或轻度升高的疗效：一项回顾性研究。
Effectiveness of antiviral treatment in HBeAg-negative chronic hepatitis B patients with normal or mildly elevated alanine aminotransferase: a retrospective study.
机构信息
State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510080, China.
Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Foshan, 528300, China.
出版信息
BMC Gastroenterol. 2022 Aug 17;22(1):387. doi: 10.1186/s12876-022-02471-y.
BACKGROUND
There are inadequate data and no histological evidence regarding the effects of antiviral treatment for hepatitis B e-antigen (HBeAg)-negative chronic hepatitis B (CHB) patients with normal or mildly elevated alanine aminotransferase (ALT). This study investigated the effects of antiviral treatment on these patients.
METHODS
We retrospectively analysed the outcomes of antiviral treatment for HBeAg-negative CHB patients with normal or mildly elevated ALT who were treated with nucleoside/nucleotide analogues (NAs) for up to 96 weeks.
RESULTS
A total of 128 patients were enrolled; 74 patients had normal ALT and 54 patients had mildly elevated ALT. The total cumulative rates of viral suppression were 64.06%, 81.97%, and 96.39%, at weeks 24, 48, and 96, respectively. The cumulative rates of viral suppression for the normal and mildly elevated ALT groups were 67.85% and 58.97%, 86.39% and 76.31%, and 93.13% and 97.04% at weeks 24, 48, and 96, respectively. The serum HBV DNA levels at week 12 and hepatitis B surface antigen (HBsAg) levels at week 24 were significant predictors of the 96-week virological response. Of the 128 patients, 54 with normal ALT and 33 with mildly elevated ALT underwent FibroScan at baseline. Significant fibrosis (F ≥ 2) was found in 44.4% (n = 24) and 51.5% (n = 17) of the patients in the normal ALT group and mildly elevated ALT group, respectively. Compared with the values at baseline, liver stiffness values significantly decreased at week 48 (8.12 kPa vs. 6.57 kPa; p < 0.001) and week 96 (8.87 kPa vs. 6.43 kPa; p < 0.001), respectively.
CONCLUSIONS
HBeAg-negative CHB patients with normal ALT could benefit from antiviral therapy with NAs, similar to patients with mildly elevated ALT. Antiviral treatment is strongly recommended for HBeAg-negative CHB patients with normal ALT. Additionally, significant liver fibrosis is not rare in HBeAg-negative CHB patients with ALT less than two-times the upper limit of normal, and FibroScan should be performed regularly for these patients.
背景
对于 HBeAg 阴性慢性乙型肝炎（CHB）患者，目前缺乏关于抗病毒治疗对正常或轻度升高丙氨酸氨基转移酶（ALT）患者的影响的数据和组织学证据。本研究旨在探讨抗病毒治疗对这些患者的影响。
方法
我们回顾性分析了应用核苷（酸）类似物（NAs）治疗 HBeAg 阴性 CHB 患者的结果，这些患者的 ALT 正常或轻度升高，疗程最长达 96 周。
结果
共纳入 128 例患者；74 例患者 ALT 正常，54 例患者 ALT 轻度升高。治疗 24、48 和 96 周时，病毒抑制的总累积率分别为 64.06%、81.97%和 96.39%。正常 ALT 组和轻度升高 ALT 组的病毒抑制累积率分别为 67.85%和 58.97%、86.39%和 76.31%、93.13%和 97.04%。治疗 12 周时的血清 HBV DNA 水平和治疗 24 周时的乙型肝炎表面抗原（HBsAg）水平是 96 周病毒学应答的显著预测因素。在 128 例患者中，54 例 ALT 正常和 33 例 ALT 轻度升高的患者在基线时进行了 FibroScan。正常 ALT 组和轻度升高 ALT 组分别有 44.4%（n=24）和 51.5%（n=17）的患者存在显著纤维化（F≥2）。与基线值相比，肝硬度值在治疗 48 周时显著下降（8.12 kPa 比 6.57 kPa；p<0.001）和治疗 96 周时显著下降（8.87 kPa 比 6.43 kPa；p<0.001）。
结论
与 ALT 轻度升高的患者相似，ALT 正常的 HBeAg 阴性 CHB 患者也可从 NAs 抗病毒治疗中获益。强烈建议对 ALT 正常的 HBeAg 阴性 CHB 患者进行抗病毒治疗。此外，ALT 小于正常上限 2 倍的 HBeAg 阴性 CHB 患者中并不少见显著肝纤维化，应定期对这些患者进行 FibroScan。
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