治疗初治、持续正常丙氨酸氨基转移酶水平的 HBeAg 阳性和阴性慢性乙型肝炎患者发生显著组织学变化的危险因素。

Risk factors for significant histological changes in both HBeAg positive and negative treatment-naive chronic hepatitis B with persistently normal alanine aminotransferase level.

机构信息

Center for General Practice Medicine, Department of Infectious Diseases, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.

School of Public Health, Hangzhou Medical College, Hangzhou, China.

出版信息

BMC Infect Dis. 2024 Oct 8;24(1):1120. doi: 10.1186/s12879-024-10015-w.

DOI:10.1186/s12879-024-10015-w

PMID:39379873

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11460226/

Abstract

BACKGROUND

Chronic hepatitis B virus (HBV) infection remains a serious health issue, and determining the optimal time for antiviral therapy is challenging. We aimed to assess liver histological changes in patients with HBeAg-positive chronic hepatitis B (CHB) and those with HBeAg-negative CHB who had persistently normal alanine aminotransferase and to determine the association between significant liver injury and various clinical parameters.

METHODS

We retrospectively included, in this study, 339 treatment-naïve patients with chronic HBV infections who had persistently normal alanine aminotransferase and underwent liver biopsy from 2013 to 2023. Histologic assessment was based on the Metavir scoring system to evaluate the association between clinical characteristics and the severity of liver inflammation and fibrosis.

RESULTS

Among the included participants, 138 were HBeAg-positive and 201 were HBeAg-negative. Lower hepatitis B surface antigen (HBsAg) (P = 0.003) and higher aspartate aminotransferase (AST) (P = 0.002) levels were associated with significant necroinflammation, whereas increasing age (P = 0.004) and lower HBV DNA (P < 0.001) levels were associated with significant fibrosis in HBeAg-positive patients with normal ALT levels. Higher HBV-DNA (P = 0.001) and AST levels(P < 0.001) were associated with significant necroinflammation, and higher AST(P < 0.001) levels were associated with significant fibrosis in HBeAg-negative patients.

CONCLUSIONS

A substantial proportion of patients with HBV infection who had normal ALT presented significant liver injury. HBsAg and AST were independent predictive factors for evaluating inflammation, while HBV DNA load and age were independent predictive factors for evaluating fibrosis in the HBeAg-positive group. HBV DNA load and AST were independent predictive factors for evaluating inflammation, while AST were independent predictive factors for evaluating fibrosis in the HBeAg-negative group.

摘要

背景

慢性乙型肝炎病毒（HBV）感染仍然是一个严重的健康问题，确定抗病毒治疗的最佳时机具有挑战性。我们旨在评估 HBeAg 阳性慢性乙型肝炎（CHB）和 HBeAg 阴性 CHB 患者持续正常丙氨酸氨基转移酶（ALT）的肝组织学变化，并确定显著肝损伤与各种临床参数之间的关系。

方法

我们回顾性纳入了这项研究中的 339 例初治慢性 HBV 感染患者，这些患者持续正常 ALT 并在 2013 年至 2023 年期间接受了肝活检。组织学评估基于 Metavir 评分系统，以评估临床特征与肝炎症和纤维化严重程度之间的关系。

结果

在纳入的参与者中，138 例为 HBeAg 阳性，201 例为 HBeAg 阴性。较低的乙型肝炎表面抗原（HBsAg）（P=0.003）和较高的天冬氨酸氨基转移酶（AST）（P=0.002）水平与显著的坏死性炎症相关，而年龄增加（P=0.004）和 HBV DNA 水平降低（P<0.001）与 HBeAg 阳性 ALT 正常水平患者的显著纤维化相关。较高的 HBV-DNA（P=0.001）和 AST 水平（P<0.001）与显著的坏死性炎症相关，而较高的 AST（P<0.001）水平与 HBeAg 阴性患者的显著纤维化相关。

结论

相当一部分 ALT 正常的 HBV 感染者存在显著的肝损伤。HBsAg 和 AST 是评估炎症的独立预测因素，而 HBV DNA 载量和年龄是 HBeAg 阳性组评估纤维化的独立预测因素。HBV DNA 载量和 AST 是评估炎症的独立预测因素，而 AST 是评估 HBeAg 阴性组纤维化的独立预测因素。