Department of Liver Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China.
The Clinical Infectious Disease Center of Nanjing, Nanjing, China
Turk J Gastroenterol. 2024 Feb 29;35(6):497-504. doi: 10.5152/tjg.2024.23512.
Background/Aims: Recent studies revealed that patients with persistent aminotransferase elevations after antiviral treatment had higher risk of hepatic events; yet its underlying causes remain unclear. Our study aimed to investigate the etiologies of persistent aminotransferase elevations in patients treated with nucleos(t)ide analogs (NAs). Materials and Methods: A retrospective study was conducted on chronic hepatitis B (CHB) patients who had been receiving NA treatment for over a year and had an aminotransferase level greater than 40 IU/mL (more than twice, with a 3-month interval) and subsequently underwent a liver biopsy. Results: The study group included 46 patients (34 males) with a mean age of 44.8 ± 20.3 years (range: 24-71 years).The average dura- tion of NA therapy was 3.7 years (1.1-10.6 years). The etiologies of persistant transaminase elevation were categorized into 4 groups: patients with low hepatitis B virus (HBV) viral load (LVL, n = 11); concurrent non-alcoholic fatty liver disease (NAFLD, n = 12); concurrent other liver diseases (OLD, n = 12); and unknown liver dysfunction (ULD, n = 11). The proportion of G ≥ 2 inflammation was significantly higher in the LVL group (90.9%) compared to NAFLD (33.3%), OLD (50%), and ULD (27.2%) groups (P = .012). The hepatitis B e-antigen (HBeAg)-positive group exhibited a younger age (34.5 ± 10.2 vs. 48.1 ± 9.4 years, P < .001), a lower proportion of fibrosis F ≥ 2 (36.3% vs. 77.1%, P = .012), and a higher prevalence of detectable HBV DNA (54.5% vs.14.2%, P = .00632) compared to the HBeAg-negative group. Conclusion: The etiology of persistent aminotransferase elevations in CHB patients undergoing NAs treatment warrants investigation. Besides the commonly observed NAFLD and low HBV viral load, concurrent presence of other liver diseases requires elucidation.The proportion of G≥2 inflammation was higher in the LVL group.
背景/目的：最近的研究表明，抗病毒治疗后持续性转氨酶升高的患者发生肝事件的风险更高；但其潜在原因仍不清楚。我们的研究旨在调查接受核苷（酸）类似物（NAs）治疗的患者持续性转氨酶升高的病因。
对接受 NA 治疗超过 1 年且转氨酶水平大于 40IU/mL（超过两倍，间隔 3 个月）且随后进行肝活检的慢性乙型肝炎（CHB）患者进行回顾性研究。
研究组包括 46 名患者（34 名男性），平均年龄为 44.8±20.3 岁（24-71 岁）。NA 治疗的平均持续时间为 3.7 年（1.1-10.6 年）。持续性转氨酶升高的病因分为 4 组：低乙型肝炎病毒（HBV）病毒载量（LVL，n=11）；合并非酒精性脂肪性肝病（NAFLD，n=12）；合并其他肝病（OLD，n=12）；和不明原因的肝功能障碍（ULD，n=11）。LVL 组 G≥2 炎症的比例明显高于 NAFLD（33.3%）、OLD（50%）和 ULD（27.2%）组（P=0.012）。HBeAg 阳性组年龄更小（34.5±10.2 岁比 48.1±9.4 岁，P＜0.001），纤维化 F≥2 的比例更低（36.3%比 77.1%，P=0.012），可检测 HBV DNA 的比例更高（54.5%比 14.2%，P=0.00632）。
接受 NAs 治疗的 CHB 患者持续性转氨酶升高的病因需要进一步研究。除了常见的 NAFLD 和低 HBV 病毒载量外，还需要阐明合并其他肝病的情况。LVL 组 G≥2 炎症的比例更高。
