Diao Yuting, Zeng Yueying, Huang Zhihao, You Chunfang
Department of Infectious Diseases, Zigong First People's Hospital, 42, Shangyihao Branch Road 1, Zigong 643000, Sichuan, China.
Can J Gastroenterol Hepatol. 2025 Mar 8;2025:7689981. doi: 10.1155/cjgh/7689981. eCollection 2025.
The efficacy of antiviral therapy in chronic hepatitis B (CHB) patients with normal alanine aminotransferase (ALT) is controversial. This study aimed to systematically review and analyze antiviral efficacy in ALT-normal CHB patients. PubMed, Embase, Web of Science, and the Cochrane Library databases from inception to 17 May 2024 were searched for retrieving relevant studies with antiviral efficacy of ALT-normal CHB patients. Of 4992 records screened, 10 studies met the criteria for inclusion and had a low risk of bias. The pooled proportions of undetectable HBV DNA, HBeAg loss, HBeAg seroconversion, HBsAg loss, and HBsAg seroconversion in ALT-normal CHB patients with antiviral therapy were 87%, 35%, 19%, 16%, and 10%, respectively. Subgroup analysis suggested that the virological and serological responses were better in patients receiving IFN-based therapy or with a longer follow-up time. Compared with no treatment, antiviral therapy was associated with significant higher rates of undetectable HBV DNA (RR: 65.62, 95% CI: 16.65-258.57, and < 0.01), HBeAg loss (RR: 14.97, 95% CI: 3.31-67.65, and < 0.01), HBsAg loss (RR: 14.22, 95% CI: 4.10-49.29, and < 0.01), and HBsAg seroconversion (RR: 24.65, 95% CI: 3.06-198.60, and < 0.01). The normal ALT group and elevated ALT group had comparable antiviral efficacy including proportions of undetectable HBV DNA, HBeAg loss, and HBeAg seroconversion ( > 0.05). CHB patients with normal ALT could benefit from antiviral therapy, and the virological and serological responses were comparable to that of ALT-elevated ones.
抗病毒治疗对丙氨酸氨基转移酶（ALT）正常的慢性乙型肝炎（CHB）患者的疗效存在争议。本研究旨在系统评价和分析ALT正常的CHB患者的抗病毒疗效。检索了PubMed、Embase、Web of Science和Cochrane图书馆数据库，从建库至2024年5月17日，以获取有关ALT正常的CHB患者抗病毒疗效的相关研究。在筛选的4992条记录中，有10项研究符合纳入标准且偏倚风险较低。接受抗病毒治疗的ALT正常的CHB患者中，HBV DNA检测不到、HBeAg消失、HBeAg血清学转换、HBsAg消失和HBsAg血清学转换的合并比例分别为87%、35%、19%、16%和10%。亚组分析表明，接受基于干扰素治疗的患者或随访时间较长的患者，其病毒学和血清学反应更好。与未治疗相比，抗病毒治疗使HBV DNA检测不到（RR：65.62，95%CI：16.65 - 258.57，P<0.01）、HBeAg消失（RR：14.97，95%CI：3.31 - 67.65，P<0.01）、HBsAg消失（RR：14.22，95%CI：4.10 - 49.29，P<0.01）和HBsAg血清学转换（RR：24.65，95%CI：3.06 - 198.60，P<0.01）的发生率显著更高。ALT正常组和ALT升高组在包括HBV DNA检测不到、HBeAg消失和HBeAg血清学转换比例在内的抗病毒疗效方面具有可比性（P>0.05）。ALT正常的CHB患者可从抗病毒治疗中获益，其病毒学和血清学反应与ALT升高的患者相当。
